Asamoah Felix, Kakourou Artemisia, Dhami Sangeeta, Lau Susanne, Agache Ioana, Muraro Antonella, Roberts Graham, Akdis Cezmi, Bonini Matteo, Cavkaytar Ozlem, Flood Breda, Izuhara Kenji, Jutel Marek, Kalayci Ömer, Pfaar Oliver, Sheikh Aziz
Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, London, UK.
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Clin Transl Allergy. 2017 Aug 2;7:25. doi: 10.1186/s13601-017-0160-0. eCollection 2017.
There is clinical uncertainty about the effectiveness and safety of allergen immunotherapy (AIT) for the treatment of allergic asthma.
To undertake a systematic overview of the effectiveness, cost-effectiveness and safety of AIT for the treatment of allergic asthma.
We searched nine electronic databases from inception to October 31, 2015. Systematic reviews were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using the Critical Appraisal Skills Programme quality assessment tool for systematic reviews. Data were descriptively and thematically synthesized.
We identified nine eligible systematic reviews; these focused on delivery of AIT through the following routes: subcutaneous (SCIT; n = 3); sublingual (SLIT; n = 4); and both SCIT and SLIT (n = 2). This evidence found that AIT delivered by SCIT and SLIT can improve medication and symptom scores and measures of bronchial hyper-reactivity. The impact on measures of lung function or asthma control was however less clear. We found no systematic review level evidence on the cost-effectiveness of SCIT or SLIT. SLIT had a favorable safety profile when compared to SCIT, particularly in relation to the risk of systemic reactions.
AIT has the potential to achieve reductions in symptom and medication scores, but there is no clear or consistent evidence that measures of lung function can be improved. Bearing in mind the limitations of synthesizing evidence from systematic reviews and the fact that these reviews include mainly dated studies, a systematic review of current primary studies is now needed to update this evidence base, estimate the effectiveness of AIT on asthma outcomes and to investigate the relative effectiveness, cost-effectiveness and safety of SCIT and SLIT.
变应原免疫疗法（AIT）治疗过敏性哮喘的有效性和安全性在临床上存在不确定性。
对AIT治疗过敏性哮喘的有效性、成本效益和安全性进行系统综述。
检索了9个电子数据库，检索时间从建库至2015年10月31日。两名评价员根据预先设定的纳入标准独立筛选系统评价，并使用系统评价的批判性评价技能计划质量评估工具进行严格评价。对数据进行描述性和主题性综合分析。
我们确定了9项符合条件的系统评价；这些评价聚焦于通过以下途径进行的AIT：皮下注射（SCIT；n = 3）；舌下含服（SLIT；n = 4）；以及皮下注射和舌下含服联合使用（n = 2）。该证据表明，皮下注射和舌下含服进行的AIT可改善用药和症状评分以及支气管高反应性指标。然而，对肺功能指标或哮喘控制的影响尚不清楚。我们未发现关于皮下注射或舌下含服成本效益的系统评价水平证据。与皮下注射相比，舌下含服具有良好的安全性，特别是在全身反应风险方面。
AIT有可能降低症状和用药评分，但尚无明确或一致的证据表明肺功能指标可得到改善。考虑到从系统评价中综合证据的局限性以及这些评价主要包括过时研究这一事实，现在需要对当前的原始研究进行系统评价，以更新这一证据库，评估AIT对哮喘结局的有效性，并研究皮下注射和舌下含服的相对有效性、成本效益和安全性。
