Demoly Pascal, Calderon Moises A, Casale Thomas B, Malling Hans-Jørgen, Wahn Ulrich
Allergy Division, Pulmonology Department, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France ; Sorbonne Universités, UPMC Paris 06, UMR-S 1136 INSERM, IPLESP, Equipe EPAR, Paris, France.
Section of Allergy and Clinical Immunology, Imperial College London-NHLI, Royal Brompton Hospital, London, UK.
Clin Transl Allergy. 2015 May 4;5:18. doi: 10.1186/s13601-015-0061-z. eCollection 2015.
Allergen immunotherapy (AIT) is a guidelines-approved, disease-modifying treatment option for respiratory allergies, including allergic rhinitis (AR) induced by pollen. The various AIT regimens employed to date in pollen-induced AR can be classified as continuous (i.e. year-round) or discontinuous (i.e. pre-seasonal alone, co-seasonal alone or pre- and co-seasonal). Pre-and co-seasonal regimens are typically used for sublingual allergen immunotherapy (SLIT) and have economic and compliance advantages over perennial (year-round) regimens. However, these advantages must not come at the expensive of poor efficacy or safety. The results of recent double-blind, placebo-controlled, randomized clinical trials show that pre- and co-seasonal SLIT is safe and effective in patients with AR induced by grass pollen (treated with a tablet formulation) or by birch pollen (treated with a liquid formulation). Progress in SLIT has been made in defining the optimal dose of major allergen, the administration frequency (daily), the duration of pre-seasonal treatment (four months) and the number of treatment seasons (at least three). Post-marketing, "real-life" trials of pre- and co-seasonal birch or grass pollen SLIT regimens have confirmed the efficacy and safety observed in the clinical trials. In the treatment of pollen-induced AR, pre- and co-seasonal SLIT regimens appear to be at least as effective and safe as perennial SLIT regimens, and are associated with lower costs and good compliance. Good compliance may mean that pre- and co-seasonal SLIT regimens are inherently more effective and safer than perennial SLIT regimens. When considering the pre- and co-seasonal discontinuous regimen in particular, a 300 IR five-grass-pollen formulation is the only SLIT tablet with a clinical development programme having provided evidence of short-term, sustained and post-treatment efficacy.
变应原免疫疗法(AIT)是一种经指南批准的、可改变疾病进程的呼吸道过敏治疗方法,包括花粉引起的过敏性鼻炎(AR)。迄今为止,用于花粉诱导性AR的各种AIT方案可分为连续(即全年)或不连续(即仅季前、仅季中或季前和季中联合)方案。季前和季中方案通常用于舌下变应原免疫疗法(SLIT),与常年(全年)方案相比,具有经济和依从性优势。然而,这些优势绝不能以疗效不佳或安全性差为代价。最近的双盲、安慰剂对照、随机临床试验结果表明,季前和季中SLIT对草花粉(用片剂治疗)或桦树花粉(用液体制剂治疗)诱导的AR患者是安全有效的。在确定主要变应原的最佳剂量、给药频率(每日)、季前治疗持续时间(四个月)和治疗季节数(至少三个)方面,SLIT已取得进展。上市后,对季前和季中桦树或草花粉SLIT方案的“真实世界”试验证实了临床试验中观察到的疗效和安全性。在治疗花粉诱导性AR方面,季前和季中SLIT方案似乎至少与常年SLIT方案一样有效和安全,且成本更低、依从性良好。良好的依从性可能意味着季前和季中SLIT方案本质上比常年SLIT方案更有效、更安全。特别是在考虑季前和季中不连续方案时,一种300 IR的五草花粉制剂是唯一一种其临床开发项目提供了短期、持续和治疗后疗效证据的SLIT片剂。