Feng Bohai, Xiang Haijie, Jin Haiyong, Gao Jinjian, Huang Saiyu, Shi Yunbin, Chen Ruru, Chen Bobei
Department of Otolaryngology, the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Allergy Asthma Immunol Res. 2017 May;9(3):220-228. doi: 10.4168/aair.2017.9.3.220.
Allergic rhinitis (AR) has become a global issue for a large part of the general population. Sublingual immunotherapy (SLIT) has been used extensively to treat persistent allergic rhinitis (PAR). Although systematic reviews have confirmed the effectiveness of SLIT for the treatment of AR, a considerable number of studies using extracts of house dust mites (HDMs) for immunotherapy found no consensus on basic treatment parameters and questioned the efficacy of SLIT.
In this study, we evaluated SLIT for PAR by a meta-analysis of randomized controlled trials (RCTs). Medline, Embase, and Cochrane Library database searches were performed for RCTs on the treatment of PAR by SLIT that assessed clinical outcomes related to efficacy through May 2016. Descriptive and quantitative information was abstracted. An analysis was performed with standardized mean differences (SMDs) under a fixed or random effects model. Subgroup analyses were performed. Heterogeneity was assessed using the I² metric.
In total, 25 studies were eligible for inclusion in the meta-analysis for symptom scores and 15 studies for medication scores. SLIT was significantly different from the controls for symptom scores (SMD=1.23; 95% confidence interval [CI]=1.74 to 0.73; P<0.001). For medication scores, significant differences for SLIT were also observed versus the controls (SMD=-1.39; 95% CI=-1.90 to -0.88; P<0.001).
Our meta-analysis indicates that SLIT provided significant symptom relief and reduced the need for medications in PAR. In this study, significant evidence was obtained despite heterogeneity with regard to the use of mite extract. Specifically, the mite extract used was provided by the patients with PAR. Furthermore, to confirm both the objective outcomes and the effective doses of HDM allergen extracts, experimental data should be obtained from large high-quality population-based studies.
变应性鼻炎（AR）已成为大部分普通人群面临的全球性问题。舌下免疫治疗（SLIT）已被广泛用于治疗持续性变应性鼻炎（PAR）。尽管系统评价已证实SLIT治疗AR的有效性，但大量使用屋尘螨（HDM）提取物进行免疫治疗的研究在基本治疗参数上未达成共识，并对SLIT的疗效提出质疑。
在本研究中，我们通过对随机对照试验（RCT）的荟萃分析评估SLIT治疗PAR的效果。检索了Medline、Embase和Cochrane图书馆数据库，查找截至2016年5月通过SLIT治疗PAR并评估与疗效相关临床结局的RCT。提取描述性和定量信息。在固定效应或随机效应模型下采用标准化均数差（SMD）进行分析。进行亚组分析。使用I²指标评估异质性。
总共25项研究符合纳入症状评分荟萃分析的标准，15项研究符合纳入药物评分荟萃分析的标准。SLIT与对照组在症状评分方面有显著差异（SMD = 1.23；95%置信区间[CI] = 1.74至0.73；P < 0.001）。对于药物评分，SLIT与对照组相比也观察到显著差异（SMD = -1.39；95% CI = -1.90至-0.88；P < 0.001）。
我们的荟萃分析表明，SLIT可显著缓解PAR症状并减少药物需求。在本研究中，尽管在螨提取物的使用方面存在异质性，但仍获得了显著证据。具体而言，所用螨提取物由PAR患者提供。此外，为了确认HDM变应原提取物的客观结局和有效剂量，应从大型高质量的基于人群的研究中获取实验数据。
