Stallergènes GmbH, Kamp-Lintfort, Germany.
Curr Med Res Opin. 2010 Apr;26(4):925-32. doi: 10.1185/03007991003659483.
To compare the effectiveness of perennial and co-seasonal high-dose sublingual immunotherapy (SLIT) treatments as well as ultra-rush and classical titrations in a real-world setting for pollen allergens.
An individual patient data (IPD) meta-analysis was performed of three open, prospective observational studies on high-dose SLIT using IR-standardised allergen extracts in patients with allergic rhinitis with and without asthma.
In total, 1052 patients aged 24.9 years (mean) were treated with SLIT and included in this IPD meta-analysis. Individual studies and total data pool analyses revealed consistent improvements in rhinoconjunctivitis symptom scores. Stratified analyses revealed consistent improvements in symptomatic score and medication score regardless of the type of sensitisation and type of treatment. Ultra-rush titration resulted in considerably more pronounced improvement in symptom scores than classical titration, possibly due to better compliance of patients receiving that supervised titration. Adverse events occurred in 24% of patients during titration and in 18% of patients during maintenance treatment. The vast majority of events (89% and 87%) were mild-to-moderate, predominantly local symptoms in the oral cavity. There were no differences detected between the study titration or treatment schedules. No serious adverse reactions were reported. Nearly all patients (88%) decided to continue SLIT after completion of the studies.
High-dose SLIT with seasonal allergens given as co-seasonal or perennial treatment appears to be effective and well-tolerated in daily medical practice. Improved compliance under ultra-rush titration and seasonal SLIT treatment may further enhance effectiveness. Randomised controlled trials are requested for the further evaluation of these findings.
比较常年和季节性高剂量舌下免疫疗法（SLIT）治疗以及花粉过敏原超快速和经典滴定法在真实环境中的疗效。
对 3 项使用标准化过敏原提取物进行高剂量 SLIT 的开放、前瞻性观察性研究进行个体患者数据（IPD）荟萃分析，纳入有或无哮喘的变应性鼻炎患者。
共有 1052 名年龄为 24.9 岁（平均）的患者接受 SLIT 治疗，并纳入本 IPD 荟萃分析。个体研究和总数据池分析均显示出鼻结膜炎症状评分的一致改善。分层分析显示，无论致敏类型和治疗类型如何，症状评分和药物评分均有一致改善。超快速滴定法导致症状评分的改善明显更为显著，可能是因为接受该监督滴定法的患者具有更好的依从性。在滴定过程中有 24%的患者发生不良事件，在维持治疗中有 18%的患者发生不良事件。绝大多数事件（89%和 87%）为轻至中度，主要为口腔局部症状。在研究滴定或治疗方案之间未发现差异。未报告严重不良反应。几乎所有患者（88%）在完成研究后决定继续 SLIT。
季节性过敏原的高剂量 SLIT 作为季节性或常年治疗似乎在日常医疗实践中是有效且耐受良好的。超快速滴定和季节性 SLIT 治疗下的依从性提高可能进一步增强疗效。需要进行随机对照试验以进一步评估这些发现。
