Larenas-Linnemann Désirée, Luna-Pech Jorge A
Research Unit, Medica Sur Hospital and Clinical Foundation, Mexico City.
Department of Philosophical, Methodological and Experimental Disciplines, University of Guadalajara, Guadalajara, Mexico.
Curr Opin Allergy Clin Immunol. 2018 Jun;18(3):168-176. doi: 10.1097/ACI.0000000000000439.
Allergen immunotherapy (AIT) is a well recognized and extensively studied therapeutic intervention for some allergic diseases. Every year new systematic reviews and meta-analysis provide the most powerful source of evidence to orient decision making on prevention or efficacy of AIT. We here discuss systematic reviews and meta-analyses on AIT (published January 2017 to February 2018).
We identified 4 systematic reviews and 10 meta-analyses. Subcutaneous and sublingual AIT (SCIT/SLIT) significantly reduced the development of asthma in children-adolescents with moderate/severe allergic rhinitis, but evidence for a short-term, preventive effect for new allergic sensitizations was nonconclusive. SCIT/SLIT proved to significantly improve symptom and medication scores versus placebo or active comparators in respiratory allergy, with various effect sizes. Oral immunotherapy for IgE-mediated food allergy resulted in substantial benefit in desensitization rates. Data on venom AIT and latex AIT, although limited in quantity and quality, respectively, suggest a large and discrete beneficial effect.
Although current evidence extracted from meta-analyses and systematic reviews support AIT as an effective, relatively safe, and well tolerated alternative for some allergic diseases, heterogeneity and some methodological inconsistencies represent matters of concern as they may affect the validity and applicability of their results, especially in the context of individual, real-life settings.
变应原免疫疗法（AIT）是一种针对某些过敏性疾病已得到充分认可且经过广泛研究的治疗干预措施。每年都会有新的系统评价和荟萃分析，为指导AIT预防或疗效方面的决策提供最有力的证据来源。我们在此讨论2017年1月至2018年2月发表的关于AIT的系统评价和荟萃分析。
我们检索到4篇系统评价和10篇荟萃分析。皮下和舌下AIT（SCIT/SLIT）显著降低了中重度过敏性鼻炎儿童及青少年哮喘的发生，但对于新的变应性致敏的短期预防作用证据尚无定论。在呼吸道过敏方面，与安慰剂或活性对照相比，SCIT/SLIT被证明能显著改善症状和用药评分，且效应大小各异。针对IgE介导的食物过敏的口服免疫疗法在脱敏率方面有显著益处。关于毒液AIT和乳胶AIT的数据，尽管数量和质量有限，但分别显示出较大且明确的有益效果。
尽管目前从荟萃分析和系统评价中提取的证据支持AIT作为某些过敏性疾病的一种有效、相对安全且耐受性良好的替代疗法，但异质性和一些方法学上的不一致性仍是令人担忧之处，因为它们可能会影响结果的有效性和适用性，尤其是在个体实际生活环境中。
