J Investig Allergol Clin Immunol. 2015;25(5):334-42.
Specific allergen immunotherapy is the only treatment modality that might change the natural course of allergic diseases in childhood. We sought to prospectively compare the long-term clinical and immunological effects of sublingual (SLIT) and subcutaneous (SCIT) immunotherapy compared with pharmacotherapy alone.
In this single-center, prospective randomized controlled trial, 48 children with mild persistent asthma with/without rhinitis, monosensitized to house dust mites (HDMs) were followed for 3 years. At baseline and years 1 and 3 of follow-up, patients were evaluated and compared for total rhinitis (TRSS) and asthma (TASS) symptom scores, total symptom scores (TSS), total medication scores (TMS), safety profiles, skin-nasal-bronchial reactivity, and immunological parameters.
A significant reduction was observed in TASS for both HDM-SCIT and HDM-SLIT at year 3 of treatment compared with baseline and controls (P<.05 for both), with significant improvement in rhinitis symptoms for both groups compared with controls (P=.01 for both). TSS decreased significantly in both HDM-SCIT and HDM-SLIT at year 3 compared with baseline (P=.007 and P=.04, respectively) and controls (P<.01 for both). A significant reduction in TMS was observed in HDM-SCIT and HDM-SLIT compared with baseline and controls (P=.01 in all cases), with a reduction in skin reactivity to HDM (P<.05). Finally, a significant increase in allergen specific IgG4 was observed in the SCIT group at year 3 compared with baseline, the SLIT group, and controls (P<.001 in all cases).
HDM-sensitized asthmatic children treated for at least 3 years with either SCIT or SLIT showed sustained clinical improvement.
特异性变应原免疫治疗是唯一可能改变儿童过敏性疾病自然进程的治疗方式。我们旨在前瞻性比较舌下（SLIT）和皮下（SCIT）免疫治疗与单独药物治疗相比的长期临床和免疫学效果。
在这项单中心前瞻性随机对照试验中，48 名患有伴/不伴鼻炎的轻度持续性哮喘、对屋尘螨（HDM）单致敏的儿童进行了 3 年的随访。在基线和随访的第 1 年和第 3 年，对患者进行评估并比较总鼻炎（TRSS）和哮喘（TASS）症状评分、总症状评分（TSS）、总药物评分（TMS）、安全性概况、皮肤-鼻-支气管反应性和免疫学参数。
与基线和对照组相比，HDM-SCIT 和 HDM-SLIT 在治疗第 3 年时 TASS 显著降低（两者均 P<.05），两组的鼻炎症状均显著改善（两者均 P=.01）。与基线相比，HDM-SCIT 和 HDM-SLIT 在第 3 年时 TSS 均显著降低（P=.007 和 P=.04），与对照组相比也显著降低（两者均 P<.01）。与基线和对照组相比，HDM-SCIT 和 HDM-SLIT 的 TMS 显著降低（所有情况下均 P=.01），对 HDM 的皮肤反应性降低（P<.05）。最后，在第 3 年时，SCIT 组的过敏原特异性 IgG4 显著增加，与基线、SLIT 组和对照组相比（所有情况下均 P<.001）。
至少接受 3 年 HDM 致敏哮喘儿童接受 SCIT 或 SLIT 治疗可获得持续的临床改善。
