Quercia O, Bruno M E, Compalati E, Falagiani P, Mistrello G, Stefanini G F
Allergological Department, U.O. Medicina, Presidio Ospedaliero di Faenza (RA), Italy.
Eur Ann Allergy Clin Immunol. 2011 Dec;43(6):176-83.
Sublingual immunotherapy (SLIT) with monomeric carbamylated allergoid proved to be well tolerated, safe and effective in patients with respiratory allergy. Standard administration regimens are expected to require a long time before clinical benefit can be appreciated. We investigated whether pre-seasonal and perennial regimens differently affect the clinical efficacy of grass pollen SLIT.
Adult patients with allergic rhino-conjunctivitis with/without mild intermittent asthma due to grass pollen were included into this open prospective study and randomised to receive SLIT with a continuous regimen (Group 1: 1,000 AU/week for the entire study period) or a pre-seasonal regimen (Group 2: 5,000 AU/week for 10 weeks/year for 2 years), or on demand drug therapy alone (Group 3) for two years. At entry (November 2005), at the end of the first and second pollen season, a Visual Analogue Scale (VAS) was used to assess patients' well-being. Symptom score and drug consumption were evaluated during the seasons. Methacholine challenge was performed at study entry and conclusion. Adverse events were recorded along the whole study duration.
Thirty-two patients were divided into Group 1 (n = 10), Group 2 (n = 11) and Group 3 (n = 11). A significant VAS improvement was observed in both SLIT groups, after the first and second pollen season, compared to baseline and to Group 3 (p < 0.05). Less symptoms and need for medications resulted during the second season (p < 0.05). No relevant variations in bronchial hyper-reactivity have been observed between the three groups. Only 2 patients experienced local or mild reactions in SLIT groups.
Both pre-seasonal and continuous regimen of SLIT with monomeric allergoid turned out effective and safe, suggesting that a pre-seasonal course with 5,000 AU/week for 10 weeks may represent a convenient option in patients with grass pollen allergic rhinitis with/without mild intermittent asthma. Further research is urgently needed to consolidate these preliminary evidences.
已证明，对于呼吸道过敏患者，使用单体氨甲酰化变应原疫苗进行舌下免疫疗法（SLIT）耐受性良好、安全且有效。标准给药方案预计需要很长时间才能显现临床益处。我们研究了季节性前和常年性方案对草花粉SLIT临床疗效的影响是否不同。
将因草花粉导致的过敏性鼻结膜炎伴/不伴轻度间歇性哮喘的成年患者纳入这项开放性前瞻性研究，并随机分为接受持续方案的SLIT组（第1组：在整个研究期间每周1000AU）或季节性前方案组（第2组：每年10周，每周5000AU，共2年），或仅接受按需药物治疗组（第3组），为期两年。在入组时（2005年11月）、第一个和第二个花粉季节结束时，使用视觉模拟量表（VAS）评估患者的健康状况。在各季节评估症状评分和药物消耗情况。在研究入组时和结束时进行乙酰甲胆碱激发试验。在整个研究期间记录不良事件。
32例患者分为第1组（n = 10）、第2组（n = 11）和第3组（n = 11）。与基线和第3组相比，在第一个和第二个花粉季节后，两个SLIT组的VAS均有显著改善（p < 0.05）。在第二个季节，症状和药物需求减少（p < 0.05）。三组之间未观察到支气管高反应性的相关变化。SLIT组中只有2例患者出现局部或轻度反应。
使用单体变应原疫苗的季节性前和持续SLIT方案均有效且安全，这表明对于伴有/不伴有轻度间歇性哮喘的草花粉过敏性鼻炎患者，每周5000AU、为期10周的季节性前疗程可能是一种方便的选择。迫切需要进一步研究来巩固这些初步证据。
