舌下和皮下免疫治疗尘螨致敏哮喘/鼻炎儿童的临床疗效和免疫机制：一项开放随机对照试验。
Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial.
机构信息
Division of Pediatric Allergy and Immunology, Marmara University Medical Faculty, Istanbul, Turkey.
出版信息
Clin Exp Allergy. 2010 Jun;40(6):922-32. doi: 10.1111/j.1365-2222.2009.03448.x. Epub 2010 Jan 20.
BACKGROUND
In children, the clinical efficacy and immunological mechanisms of sublingual immunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to be elucidated.
OBJECTIVES
To compare SLIT, SCIT and pharmacotherapy in relation to clinical efficacy and immunological mechanisms that govern its effect in asthmatic/rhinitis children who were sensitized to house dust mite (HDM).
METHODS
In this single centre, prospective, randomized, controlled, open labelled, three parallel group trial, 48 patients mono-sensitized to HDM were randomized to receive either SLIT (n=16), SCIT (n=16) or pharmacotherapy alone (n=16). Symptom, medication and visual analogue score (VAS) were collected and bronchial-nasal hyper-reactivity, skin prick tests, total-specific IgE were performed at baseline and 12 months after treatment. In addition, peripheral blood mononuclear cells were cultured with recombinant Der p 1 and Bet v 1 extracts and allergen-specific IL-4, IL-5, IL-13, IFN-gamma, IL-10, and TGF-beta secretions were measured.
RESULTS
SLIT and SCIT demonstrated a significant reduction of total rhinitis and asthma symptom score, total medication score, VAS and skin reactivity to HDM (P<0.05) when compared with pharmacotherapy. A significant reduction of serum-specific HDM-IgE in SCIT and SLIT were observed. Moreover, titrated nasal provocative dose significantly increased in both immunotherapy groups when compared with the pharmacotherapy group. No adverse effects were reported in SLIT, while two patients demonstrated serious adverse events in SCIT. After 1 year of treatment, Der p 1-driven IL-10 significantly increased in SLIT compared with pharmacotherapy, whereas Bet v 1-driven TGF-beta (negative control) increased significantly in SLIT only. No changes were observed for Th1-Th2 cytokines.
CONCLUSION
Both SLIT and SCIT demonstrated clinical improvement compared with pharmacotherapy in asthma/rhinitis children sensitized to HDM.
背景
在儿童中，舌下免疫疗法（SLIT）与皮下免疫疗法（SCIT）的临床疗效和免疫机制仍有待阐明。
目的
比较 SLIT、SCIT 和药物治疗在控制尘螨（HDM）致敏哮喘/鼻炎儿童疗效方面的临床疗效和免疫机制。
方法
在这项单中心、前瞻性、随机、对照、开放标签、三平行组试验中，48 名单一致敏于 HDM 的患者被随机分为接受 SLIT（n=16）、SCIT（n=16）或单独药物治疗（n=16）。在基线和治疗 12 个月后，收集症状、药物使用和视觉模拟评分（VAS），并进行支气管-鼻高反应性、皮肤点刺试验和总特异性 IgE 检测。此外，用重组 Der p 1 和 Bet v 1 提取物培养外周血单个核细胞，并测量过敏原特异性 IL-4、IL-5、IL-13、IFN-γ、IL-10 和 TGF-β的分泌。
结果
与药物治疗相比，SLIT 和 SCIT 均显著降低了总鼻炎和哮喘症状评分、总药物评分、VAS 和对 HDM 的皮肤反应（P<0.05）。在 SCIT 和 SLIT 中观察到血清特异性 HDM-IgE 显著降低。此外，与药物治疗组相比，两种免疫治疗组的鼻激发剂量均显著增加。SLIT 组无不良反应报告，而 SCIT 组有 2 例出现严重不良反应。治疗 1 年后，与药物治疗相比，SLIT 中 Der p 1 驱动的 IL-10 显著增加，而 SLIT 中 Bet v 1 驱动的 TGF-β（阴性对照）显著增加。Th1-Th2 细胞因子没有变化。
结论
与药物治疗相比，SLIT 和 SCIT 均在哮喘/鼻炎儿童中显示出临床改善。
Zotero 插件