Živković Zorica, Djurić-Filipović Ivana, Živanović Snežana
Srp Arh Celok Lek. 2016 May-Jun;144(5-6):345-50.
In 1993 the European Academy of Allergy and Clinical Immunology was the first official organization to recognize that sublingual administration could be “promising route” for allergic desensitization. A few years later, the World Health Organization recommended this therapy as “a viable alternative to the injection route in adults.” The first meta-analysis showed sublingual allergen specific immunotherapy (SLIT) effectiveness for allergic rhinitis and another study showed SLIT can actually help prevent the development of asthma both in adults and in children. The main goal of this review article is to present insight into the most up-to-date understanding of the clinical efficacy and safety of immunotherapy in the treatment of pediatric patients with allergic rhinitis and asthma. A literature review was performed on PubMed from 1990 to 2015 using the terms “asthma,” “allergic rhinitis,” “children,” “allergen specific immune therapy.” Evaluating data from double-blind placebo-controlled randomized clinical trials (DB-PC-RCTs), the clinical efficacy (assessed as the reduction of symptom score and the need of rescue medicament) of SLIT for allergic rhinitis and allergic asthma, has been confirmed in various meta-analysis Outcomes such as rhinoconjunctivitis score and medication scores, combined scores, quality of life, days with severe symptoms, immunological endpoints, and safety parameters were all improved in the SLIT-tablet compared with placebo group. SLIT safety has been already proven in many DB-PC-RCTs and real-life settings. In accordance with all of the above mentioned, the goals for future trials and studies are the development of comprehensive guidelines for clinical practice on immunotherapy, embracing all the different potential participants. The importance of allergen immunotherapy is of special relevance in the pediatric age, when the plasticity and modulability of the immune system are maximal, and when preventative effects can be reasonably expected.
1993年，欧洲变态反应和临床免疫学会成为首个正式认可舌下给药可能是变应性脱敏“有前景途径”的官方组织。几年后，世界卫生组织推荐这种疗法为“成人注射途径的可行替代方法”。第一项荟萃分析显示舌下变应原特异性免疫疗法（SLIT）对变应性鼻炎有效，另一项研究表明SLIT实际上有助于预防成人和儿童哮喘的发生。这篇综述文章的主要目的是深入探讨免疫疗法治疗小儿变应性鼻炎和哮喘的临床疗效及安全性的最新认识。使用“哮喘”“变应性鼻炎”“儿童”“变应原特异性免疫疗法”等术语，于1990年至2015年在PubMed上进行了文献综述。通过评估双盲安慰剂对照随机临床试验（DB-PC-RCTs）的数据，SLIT治疗变应性鼻炎和变应性哮喘的临床疗效（以症状评分降低和急救药物需求评估）已在各种荟萃分析中得到证实。与安慰剂组相比，SLIT片剂在鼻结膜炎评分、药物评分、综合评分、生活质量、重度症状天数、免疫终点和安全性参数等方面均有改善。SLIT的安全性已在许多DB-PC-RCTs和实际应用中得到证实。根据上述所有内容，未来试验和研究的目标是制定免疫疗法临床实践综合指南，涵盖所有不同的潜在参与者。变应原免疫疗法在儿童期尤为重要，此时免疫系统的可塑性和可调节性最大，且可合理预期预防效果。
