Brunton Stephen, Nelson Harold S, Bernstein David I, Lawton Simon, Lu Susan, Nolte Hendrik
a Primary Care Respiratory Group , Lake View Terrace , CA , USA.
b Department of Medicine , National Jewish Health , Denver , CO , USA.
Postgrad Med. 2017 Aug;129(6):581-589. doi: 10.1080/00325481.2017.1308208. Epub 2017 Mar 27.
Allergic rhinitis (AR) with or without conjunctivitis (AR/C) is associated with a significant health and economic burden, and is often accompanied by asthma. Pharmacotherapies are the mainstay treatment options for AR and asthma, but guidelines also recommend allergy immunotherapy (AIT). Unlike pharmacotherapies, AIT has the ability to modify the underlying immunologic mechanisms of AR and asthma with the potential for long-term benefits after treatment is discontinued. Immunotherapy may also prevent progression of AR/C to asthma. Sublingual immunotherapy (SLIT)-tablets are a self-administered alternative to subcutaneous immunotherapy that provide the benefits of AIT without the cost and inconvenience of frequent office visits or the discomfort of injections. SLIT-tablets are also an option that can be utilized by primary care clinicians. Pharmacotherapies are generally effective in mild disease although a number of patients remain uncontrolled. SLIT-tablets have proven efficacy for AR in adults, children, and poly-sensitized allergic patients. Indirect comparisons indicate that SLIT-tablets have superior or comparable efficacy compared with traditional pharmacotherapies for seasonal AR, and superior efficacy for perennial AR. House dust mite (HDM) SLIT-tablets have also demonstrated clinically relevant benefits for asthma, with significant observed reductions in daily inhaled corticosteroid use, risk of asthma exacerbations, and asthma symptoms. SLIT-tablets are well tolerated, with minimal risk of systemic allergic reactions. The most common treatment-related adverse events are oral site reactions such as oral pruritus and throat irritation. Based on the favorable efficacy and safety profile, as well as the convenience of at-home oral administration and disease-modifying effects, SLIT-tablets should be considered as an alternative or add-on treatment to pharmacotherapy for AR/C, and as an add-on treatment for HDM allergic asthma.
伴有或不伴有结膜炎的变应性鼻炎（AR/C）会带来巨大的健康和经济负担，且常伴有哮喘。药物治疗是AR和哮喘的主要治疗选择，但指南也推荐变应原免疫疗法（AIT）。与药物治疗不同，AIT有能力改变AR和哮喘的潜在免疫机制，在治疗停止后可能带来长期益处。免疫疗法还可预防AR/C发展为哮喘。舌下免疫疗法（SLIT）片剂是皮下免疫疗法的一种可自行给药的替代方法，可提供AIT的益处，而无需频繁门诊的费用和不便，也不会有注射带来的不适。SLIT片剂也是初级保健临床医生可采用的一种选择。药物治疗对轻度疾病通常有效，尽管仍有一些患者病情控制不佳。SLIT片剂已被证明对成人、儿童和多敏性变应性患者的AR有效。间接比较表明，与传统药物治疗相比，SLIT片剂对季节性AR具有 superior 或相当的疗效，对常年性AR具有 superior 疗效。屋尘螨（HDM）SLIT片剂也已证明对哮喘具有临床相关益处，观察到每日吸入性糖皮质激素的使用、哮喘加重风险和哮喘症状均有显著降低。SLIT片剂耐受性良好，全身过敏反应风险极小。最常见的与治疗相关的不良事件是口腔局部反应，如口腔瘙痒和咽喉刺激。基于良好的疗效和安全性，以及居家口服给药的便利性和疾病改善作用，SLIT片剂应被视为AR/C药物治疗的替代或附加治疗方法，以及HDM过敏性哮喘的附加治疗方法。
原文中superior重复出现，可能存在错误，暂按原文翻译。
