Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA 19104, USA.
Int Forum Allergy Rhinol. 2013 Jul;3(7):519-31. doi: 10.1002/alr.21141. Epub 2013 Jan 11.
Allergic rhinitis is a common allergic disease with increasing prevalence in Western Societies. Medical therapy is first line treatment, and is aimed at reducing symptoms of immunoglobulin E (IgE)-mediated inflammation of the nasal passages. In patients with disease refractory to medical therapy, subcutaneous immunotherapy is an option. The aim of this study is to update a recent Cochrane review with available level 1 evidence for seasonal and perennial allergic rhinitis.
A systematic review of the literature was performed from 2006 to 2011 and compared with data from a 2007 Cochrane review on immunotherapy for seasonal allergic rhinitis. We included all studies of level 1 evidence. All forms of single extract immunotherapy were considered. Studies with primary asthma related end-points were excluded. Primary end-points were instruments of clinical efficacy (ie, symptom-medication scores) and adverse events.
We retrieved 12 level 1 studies for review. In total, 1512 patients were randomized into treatment groups, alternative study groups (alternative duration of therapy or sublingual immunotherapy [SLIT]), or placebo. Efficacy was evaluated based on reported symptom and/or medication score, validated quality of life instruments, immunological assays, challenge testing, and adverse events.
Subcutaneous immunotherapy improves symptom and/or medication scores and validated quality of life measures. In addition, associated changes in surrogate markers of immunologic protection are observed. Subcutaneous immunotherapy is safe when administered to carefully selected patients and in settings capable of responding to systemic reactions. Subcutaneous immunotherapy is recommended for patients with seasonal or perennial allergic rhinitis not responsive to conservative medical therapy, and whose symptoms significantly affect quality of life.
变应性鼻炎是一种常见的过敏性疾病，在西方社会的发病率呈上升趋势。药物治疗是一线治疗方法，旨在减轻 IgE 介导的鼻道炎症症状。对于药物治疗无效的患者，皮下免疫疗法是一种选择。本研究旨在更新最近的 Cochrane 综述，提供季节性和常年性变应性鼻炎的现有 1 级证据。
从 2006 年到 2011 年进行了文献系统评价，并与 2007 年关于季节性变应性鼻炎免疫疗法的 Cochrane 综述的数据进行了比较。我们纳入了所有 1 级证据的研究。考虑了所有单一提取物免疫疗法的形式。排除了以主要哮喘相关终点为研究目的的研究。主要终点是临床疗效的指标（即症状-药物评分）和不良事件。
我们检索到 12 项 1 级研究进行综述。共有 1512 名患者被随机分配到治疗组、替代研究组（替代治疗时间或舌下免疫疗法[SLIT]）或安慰剂组。疗效根据报告的症状和/或药物评分、验证的生活质量量表、免疫测定、挑战测试和不良事件进行评估。
皮下免疫疗法可改善症状和/或药物评分以及验证的生活质量指标。此外，还观察到与免疫保护替代标志物相关的变化。在仔细选择的患者中，在能够应对全身反应的环境中，皮下免疫疗法是安全的。皮下免疫疗法推荐用于对保守药物治疗无反应、症状严重影响生活质量的季节性或常年性变应性鼻炎患者。
