Imperial College-National Heart & Lung Institute, Royal Brompton Hospital, London, UK.
J Allergy Clin Immunol. 2012 Apr;129(4):929-34. doi: 10.1016/j.jaci.2011.11.019. Epub 2012 Jan 11.
In allergen immunotherapy there is debate as to whether polysensitized patients are best treated with many allergens simultaneously (chosen according to the sensitization profile, a predominantly North American approach) or a single allergen (chosen according to the most clinically problematic allergy, a predominantly European approach). In patients seeking treatment for moderate-to-severe respiratory allergies, polysensitization is more prevalent (range, 50% to 80%) than monosensitization in both the United States and Europe. Safe, effective, single-allergen preparations will most likely have been tested in polysensitized patients. In robust, large-scale clinical trials of grass pollen sublingual tablets, polysensitized patients benefited at least as much from allergen immunotherapy as monosensitized patients. A recent review of multiallergen immunotherapy concluded that simultaneous delivery of multiple unrelated allergens can be clinically effective but that there was a need for additional investigation of therapy with more than 2 allergen extracts (particularly in sublingual allergen immunotherapy). More work is also required to determine whether single-allergen and multiallergen immunotherapy protocols elicit distinct immune responses in monosensitized and polysensitized patients. Sublingual and subcutaneous multiallergen immunotherapy in polysensitized patients requires more supporting data to validate its efficacy in practice.
在变应原免疫治疗中，存在一个争议，即多敏患者是同时接受多种变应原治疗（根据致敏情况选择，这主要是北美的方法）还是接受单一变应原治疗（根据最具临床问题的过敏选择，这主要是欧洲的方法）更好。在美国和欧洲，寻求中重度呼吸道过敏治疗的患者中，多敏患者比单敏患者更为常见（范围为 50%至 80%）。安全有效的单一变应原制剂很可能已经在多敏患者中进行了测试。在大规模、大规模的舌下草花粉片临床试验中，多敏患者从变应原免疫治疗中获益至少与单敏患者一样多。最近对多过敏原免疫治疗的综述得出结论，同时给予多种不相关的过敏原可能具有临床疗效，但需要对超过 2 种过敏原提取物的治疗进行更多研究（特别是在舌下过敏原免疫治疗中）。还需要做更多的工作来确定单抗原和多抗原免疫疗法方案是否会在单敏和多敏患者中引起不同的免疫反应。在多敏患者中进行舌下和皮下多抗原免疫治疗需要更多的支持数据来验证其在实践中的疗效。
