Sun Jinqiao, Hui Xiaoying, Ying Wenjing, Liu Danru, Wang Xiaochuan
Department of Clinical Immunology, Children's Hospital of Fudan University, Shanghai, China.
Allergy Asthma Proc. 2014 Mar-Apr;35(2):171-7. doi: 10.2500/aap.2014.35.3730.
Peanut allergy is one of the most common food allergies. Allergen-specific oral immunotherapy (OIT) and sublingual immunotherapy (SLIT) for peanut allergy aim to induce desensitization and then tolerance to peanuts. However, there is still considerable uncertainty about the safety of these two approaches and if the risk is justified by the benefit of the therapy. We performed a systematic review and meta-analysis to assess the efficacy and safety of OIT and SLIT in patients with peanut allergy. We performed searches of the MEDLINE, CINAHL, EMBASE, ISI Web of Science, and Cochrane databases (through March 18, 2013) for randomized controlled trials (RCTs) that compared OIT or SLIT with a placebo in patients with peanut allergy. The study selection and data extraction were independently performed by two reviewers. The primary outcome was the proportion of patients whose condition improved. We also analyzed immunologic changes and adverse events. A meta-analysis was performed using a random effects model. Three RCTs that comprised a total of 86 subjects were analyzed. OIT or SLIT had a significantly positive effect on peanut allergy (odds ratio [OR], 38.44; 95% confidential interval [CI], 6.01-245.81). Several immunologic changes associated with the induction of tolerance were improvements. There is no difference between the OIT or SLIT group and placebo group in the number of patients who required epinephrine during the study (OR, 0.51; 95% CI, 0.03-10.20). This study showed a statistically significant benefit of peanut immunotherapy in patients with peanut allergy. However, these findings are based on an analysis of a small number of RCTs. Additional larger, well-designed and double-blind RCTs are needed.
花生过敏是最常见的食物过敏之一。针对花生过敏的过敏原特异性口服免疫疗法（OIT）和舌下免疫疗法（SLIT）旨在诱导脱敏，进而使患者对花生产生耐受性。然而，这两种方法的安全性以及治疗益处是否能抵消风险仍存在相当大的不确定性。我们进行了一项系统评价和荟萃分析，以评估OIT和SLIT在花生过敏患者中的疗效和安全性。我们检索了MEDLINE、CINAHL、EMBASE、ISI科学网和Cochrane数据库（截至2013年3月18日），查找比较OIT或SLIT与安慰剂治疗花生过敏患者的随机对照试验（RCT）。研究筛选和数据提取由两名审阅者独立进行。主要结局是病情改善的患者比例。我们还分析了免疫变化和不良事件。使用随机效应模型进行荟萃分析。分析了3项共纳入86名受试者的RCT。OIT或SLIT对花生过敏有显著的积极效果（优势比[OR]，38.44；95%可信区间[CI]，6.01 - 245.81）。与耐受性诱导相关的一些免疫变化有所改善。在研究期间需要肾上腺素治疗的患者数量方面，OIT或SLIT组与安慰剂组之间没有差异（OR，0.51；95% CI，0.03 - 10.20）。这项研究表明花生免疫疗法对花生过敏患者有统计学上的显著益处。然而，这些发现基于对少数RCT的分析。还需要更多规模更大、设计良好的双盲RCT。
