Dominguez-Ortega J, Delgado J, Blanco C, Prieto L, Arroabarren E, Cimarra M, Henriquez-Santana A, Iglesias-Souto J, Vega-Chicote J M, Tabar A I
Servicio de Alergología, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.
Unidad de Gestión Clínica de Alergología, Hospital Virgen Macarena, Sevilla, Spain.
J Investig Allergol Clin Immunol. 2017 Jun;27(Suppl. 1):1-35. doi: 10.18176/jiaci.0149.
Asthma is frequently associated with atopy, characterized by the production of specific immunoglobulin E in response to environmental allergens. Currently, two types of allergen immunotherapy (AIT) are used in clinical practice: subcutaneous and sublingual immunotherapy, both accepted as key components of the therapeutic repertoire for allergic rhinitis and conjunctivitis. However, their role in asthma remains controversial. The present document is aimed at providing the clinicians with a review of the evidence on the use of AIT in asthma, focusing on the most relevant aspects of its mechanism of action, its efficacy, and existing data on safety, tolerability, and cost-effectivity, both in pediatric and adult populations. A systematic search of MEDLINE, Cochrane, and Clinical Trials databases from 2000 to April of 2016 was carried out by a panel of experts from the Spanish Allergy and Clinical Immunology Scientific Society. Relevant studies prior to the year 2000 included in ulterior systematic reviews were also considered. More than 4000 articles were identified during the search and 241 were selected to retrieve available evidence on AIT, which was graded according to the Oxford classification. All the group members reviewed the resulting text until the final version reached the consensual agreement. A summary of recommendations on the more relevant topics are proposed. The role of AIT as a valuable therapeutic strategy for prevention of exacerbation and progressive decline in lung function is highlighted. Future research should include specific tools for asthma evaluation when assessing AIT effectiveness in asthmatic patients.
哮喘常与特应性相关，其特征是针对环境过敏原产生特异性免疫球蛋白E。目前，临床实践中使用两种类型的变应原免疫疗法（AIT）：皮下免疫疗法和舌下免疫疗法，这两种疗法均被视为变应性鼻炎和结膜炎治疗方法的关键组成部分。然而，它们在哮喘治疗中的作用仍存在争议。本文件旨在为临床医生提供有关AIT在哮喘治疗中应用的证据综述，重点关注其作用机制、疗效以及儿科和成人人群中关于安全性、耐受性和成本效益的现有数据等最相关方面。西班牙变态反应与临床免疫科学学会的专家小组对2000年至2016年4月期间的MEDLINE、Cochrane和临床试验数据库进行了系统检索。2000年之前纳入后续系统评价的相关研究也被纳入考虑。检索过程中识别出4000多篇文章，从中选择了241篇以获取关于AIT的现有证据，并根据牛津分类法进行分级。所有小组成员对最终文本进行审核，直至最终版本达成共识。文中提出了关于更相关主题的建议总结。强调了AIT作为预防哮喘发作和肺功能进行性下降的一种有价值治疗策略的作用。未来的研究在评估AIT对哮喘患者的有效性时应包括评估哮喘的特定工具。
