Marogna M, Braidi C, Bruno M E, Colombo C, Colombo F, Massolo A, Palumbo L, Compalati E
Cuasso al Monte, Macchi Hospital Foundation, Varese, Italy.
Allergol Immunopathol (Madr). 2013 Jul-Aug;41(4):216-24. doi: 10.1016/j.aller.2012.07.004. Epub 2012 Nov 9.
Asthma control represents the main goal of asthma management and different strategies aim to avoid the long term downsides of inhaled corticosteroids. We investigated in real-life conditions the contribution of sublingual immunotherapy in achieving the control of birch-related mild persistent asthma compared to two usual step-up therapeutic options.
A three-year open randomised study included 84 asthmatics, uncontrolled during the previous birch pollen season, despite a treatment with budesonide 400μg/day. Patients randomly received budesonide 800μg/day, budesonide 1600μg/day, budesonide 400μg/day plus montelukast 10μg/day and budesonide 400μg/day plus carbamylated allergoid of betulaceae pre-coseasonally. Asthma Control test, combined allergy symptoms and medications score, albuterol consumption, lung function, nasal eosinophils and nasal steroids usage were assessed as changes from the first to last pollen season.
Seventy-six patients concluded the study. All options, except budesonide 800μg/day, produced an improvement of mean monthly Asthma Control test (p<0.05). Patients undergoing low-dose budesonide plus immunotherapy achieved, after three years, an appreciable control (ACT mean score 24). A significant improvement was seen in all groups for allergy symptoms plus medications and bronchial reactivity. Albuterol consumption and lung function improved in all but the first group. Only budesonide plus immunotherapy reduced nasal eosinophils and nasal steroids usage. Two mild self-resolving adverse events were reported.
For patients with respiratory allergy due to birch pollen and mild persistent asthma, sublingual immunotherapy added to low-dose inhaled corticosteroids appears effective in maintaining long-term seasonal asthma control, representing a safe opportunity to reduce the cumulative amount of delivered corticosteroids.
哮喘控制是哮喘管理的主要目标，不同策略旨在避免吸入性糖皮质激素的长期不良影响。我们在现实生活条件下研究了与两种常规逐步升级治疗方案相比，舌下免疫疗法在实现桦树相关轻度持续性哮喘控制方面的作用。
一项为期三年的开放随机研究纳入了84名哮喘患者，尽管此前使用400μg/天的布地奈德进行治疗，但在上一个桦树花粉季节期间病情未得到控制。患者被随机分为接受800μg/天布地奈德、1600μg/天布地奈德、400μg/天布地奈德加10μg/天孟鲁司特以及400μg/天布地奈德加桦木科预季节化氨基甲酰化变应原。评估哮喘控制测试、综合过敏症状和药物评分、沙丁胺醇用量、肺功能、鼻嗜酸性粒细胞和鼻用类固醇使用情况从第一个到最后一个花粉季节的变化。
76名患者完成了研究。除800μg/天布地奈德外，所有方案均使平均每月哮喘控制测试得到改善（p<0.05）。接受低剂量布地奈德加免疫疗法的患者在三年后实现了可观的控制（ACT平均得分24）。所有组的过敏症状加药物和支气管反应性均有显著改善。除第一组外，所有组的沙丁胺醇用量和肺功能均有所改善。只有布地奈德加免疫疗法降低了鼻嗜酸性粒细胞和鼻用类固醇的使用。报告了两例轻度自行缓解的不良事件。
对于因桦树花粉和轻度持续性哮喘导致呼吸道过敏的患者，低剂量吸入性糖皮质激素加舌下免疫疗法似乎可有效维持季节性哮喘的长期控制，是减少糖皮质激素累积用量的安全选择。
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