Hospital Médica Sur, Mexico City, Mexico.
Ann Allergy Asthma Immunol. 2013 Jun;110(6):402-415.e9. doi: 10.1016/j.anai.2013.02.017. Epub 2013 Apr 16.
To perform a structured analysis of the latest scientific evidence obtained for the clinical efficacy of sublingual immunotherapy (SLIT) in children.
PubMed, Embase, reference lists from reviews, and personal databases were reviewed for original articles on clinical trials with SLIT in patients younger than 18 years published from January 1, 2009, through December 31, 2012, using broad search and medical subject heading terms.
Clinical trials, irrespective of their design, of SLIT in the treatment of respiratory and food allergy in patients 18 years or younger were selected. Clinical outcomes (symptom scores, medication use, provocation tests, pulmonary function tests, skin prick tests, and adverse events) and immunologic changes were tabulated. Quality of each trial and total quality of compounded evidence was analyzed with the Grading of Recommendations Assessment, Development and Evaluation system.
Of 56 articles, 29 met the inclusion criteria. New evidence is robust for the precoseasonal tablet and drop grass pollen SLIT efficacy in allergic rhinitis and scarce for seasonal asthma. Some evidence for Alternaria SLIT efficacy is appearing. For house dust mite (HDM) SLIT in asthma, there is high-quality evidence for medication reduction while maintaining symptom control; evidence for HDM SLIT efficacy in allergic rhinitis is of moderate-low quality. There is moderate evidence for efficacy of dual grass pollen-HDM SLIT after 12 months of treatment and 1 year after discontinuation. Specific provocation test results (nasal, skin) improve with grass pollen and HDM SLIT but nonspecific bronchial provocation testing does not. Food oral immunotherapy is more promising than food SLIT. Possible new surrogate markers have been reported. No anaphylaxis was found among 2469 treated children.
Evidence for efficacy of SLIT in children with respiratory or food allergy is growing.
对舌下免疫疗法（SLIT）在儿童中的临床疗效的最新科学证据进行系统分析。
检索了 2009 年 1 月 1 日至 2012 年 12 月 31 日期间发表的有关 SLIT 治疗 18 岁以下患者的呼吸和食物过敏的临床试验的原始文章，使用广泛的搜索和医学主题词，检索了 PubMed、Embase、综述的参考文献列表以及个人数据库。
选择了 SLIT 治疗 18 岁或以下患者呼吸道和食物过敏的临床试验，无论其设计如何。列出了临床结果（症状评分、药物使用、激发试验、肺功能试验、皮肤点刺试验和不良事件）和免疫变化。使用推荐评估、制定和评估系统（Grading of Recommendations Assessment, Development and Evaluation system）分析每个试验的质量和综合证据的总质量。
在 56 篇文章中，有 29 篇符合纳入标准。花粉过敏季节前片剂和滴剂草花粉 SLIT 在过敏性鼻炎中的疗效有新的强有力证据，季节性哮喘的证据较少。出现了一些关于交链孢霉 SLIT 疗效的证据。对于尘螨（HDM）SLIT 在哮喘中的疗效，有高质量的证据表明在维持症状控制的同时减少药物使用；在过敏性鼻炎中的证据质量为中低。在停止治疗 1 年后，经过 12 个月的治疗，双花粉-HDM SLIT 的疗效有中度证据。草花粉和 HDM SLIT 可改善特定激发试验（鼻、皮肤）结果，但非特异性支气管激发试验则不然。食物口服免疫疗法比食物 SLIT 更有前景。已报告了一些新的可能替代标志物。在 2469 名接受治疗的儿童中未发现过敏反应。
SLIT 在儿童呼吸道或食物过敏中的疗效证据正在增加。
