Department of Respiratory Diseases, Aarhus University Hospital, Aarhus C, Denmark.
Allergy. 2011 Feb;66(2):178-85. doi: 10.1111/j.1398-9995.2010.02451.x. Epub 2010 Sep 30.
Specific immunotherapy is the only treatment with the potential to prevent progression of the allergic disease and the potential to cure patients. The immunomodulatory ability of SQ-standardized house dust mite (HDM) subcutaneous immunotherapy (SCIT) was investigated in patients with allergic asthma.
Fifty-four adults with HDM-allergic asthma were randomized 1:1 to receive SQ-standardized HDM SCIT (ALK) or placebo for 3 years. At baseline, and after 1, 2 and 3 years of treatment, the lowest possible inhaled corticosteroid dose required to maintain asthma control was determined, followed by determinations of nonspecific and HDM-allergen-specific bronchial hyperresponsiveness, late asthmatic reaction (LAR), immediate and late-phase skin reactions, and immunological response.
SQ-standardized HDM SCIT provided a statistically significantly higher HDM-allergen tolerance (P<0.05 vs placebo) in terms of a 1.6-fold increase in PD(20) (HDM-allergen inhalation challenge), a 60-fold increase in skin test histamine equivalent HDM-allergen concentrations, reduced immediate- and reduced or abolished late-phase skin reactions, as well as fewer patients with LAR. PD(20) (methacholine inhalation challenge) increased initially and was similar between groups. House dust mite SCIT induced an initial increase in serum HDM-allergen-specific IgE (P=0.028 vs placebo), which then declined to baseline value. House dust mite SCIT induced an increase in components blocking IgE binding to allergen [ΔIgE-blocking factor: 0.31; 95% CI of (0.26; 0.37)] after 1 year that remained constant after 2 and 3 years (P < 0.0001 vs placebo).
SQ-standardized HDM SCIT induced a consistent immunomodulatory effect in adults with HDM-allergic asthma; the humoral immune response was changed and the HDM-allergen tolerance in lung and skin increased.
特异性免疫疗法是唯一具有预防过敏疾病进展和治愈患者潜力的治疗方法。本研究旨在探讨标准化屋尘螨皮下免疫治疗(SCIT)对过敏性哮喘患者的免疫调节作用。
54 例屋尘螨过敏哮喘患者按 1:1 随机分为 SQ 标准化屋尘螨 SCIT(ALK)组或安慰剂组,治疗 3 年。在基线、治疗 1、2 和 3 年后,确定维持哮喘控制所需的最低可能吸入性皮质类固醇剂量,随后测定非特异性和屋尘螨过敏原特异性支气管高反应性、迟发哮喘反应(LAR)、即刻和迟发皮肤反应以及免疫反应。
SQ 标准化屋尘螨 SCIT 提供了统计学上显著更高的屋尘螨过敏原耐受性(与安慰剂相比,PD20(屋尘螨吸入挑战)增加 1.6 倍,皮试组胺当量屋尘螨浓度增加 60 倍,即刻和迟发皮肤反应减少或消除,LAR 患者减少)。PD20(乙酰甲胆碱吸入挑战)最初增加,两组之间相似。屋尘螨 SCIT 诱导血清屋尘螨过敏原特异性 IgE 初始增加(与安慰剂相比,P=0.028),然后降至基线值。屋尘螨 SCIT 诱导 IgE 结合过敏原的阻断成分增加[ΔIgE 阻断因子:0.31;95%置信区间(0.26;0.37)],1 年后保持不变,2 年和 3 年后仍保持不变(与安慰剂相比,P < 0.0001)。
SQ 标准化屋尘螨 SCIT 可在屋尘螨过敏哮喘成人中诱导一致的免疫调节作用;体液免疫反应发生变化,肺和皮肤对屋尘螨过敏原的耐受性增加。