Nelson Harold S
Allergy Asthma Proc. 2018 Jul 1;39(4):264-272. doi: 10.2500/aap.2018.39.4145.
Since the discovery of house-dust mites (HDM) in the 1960's, allergy immunotherapy trials that used extracts of these mites have been conducted, first by subcutaneous (SCIT) and later by the sublingual (SLIT) route. When reviewed in 2013, published studies of HDM immunotherapy were found to often be characterized by small sample size, widely varying doses, and poorly defined disease severity and outcomes. These trials were thought to to support the efficacy of HDM subcutaneous allergy immunotherapy but the evidence for efficacy of sublingual immunotherapy was less firm.
This report will review a large number of well-designed studies reported since 2013, mostly of SLIT, and in particular, of two newly developed HDM sublingual tablets. In addition, other aspects of HDM immunotherapy will be addressed, including use in atopic dermatitis, optimum duration of treatment, evidence for disease modification and use with adjuvants.
Seventeen reports on 15 randomized, double-blind, placebo-controlled trials were identified as having been published since the cut-off date of the 2013 systematic review. Twelve of these reported results with the 2 HDM SLIT-tablets. These studies clearly established the appropriate doses and the efficacy and safety of these tablets in treating allergic rhinitis and asthma. Other reports offered support for use of HDM immunotherapy in selected patients with atopic dermatitis, for administration of HDM immunotherapy for 3 to 5 years, for anticipating disease modification after 3-5 years of treatment, and for the use of vitamin D and selected probiotics to enhance its efficacy.
HDM SCIT and SLIT-tablet therapy have demonstrated effectiveness in allergic rhinitis and asthma. Appropriate dosing with HDM SLIT-liquid has not been established although a limited number of studies suggest it can be effective as well. HDM SCIT and HDM SLIT share efficacy in allergic rhinitis and asthma, disease modification and the duration of treatment required to produce persisting benefit.
自20世纪60年代发现屋尘螨（HDM）以来，人们开展了使用这些螨提取物的变应原免疫疗法试验，最初是皮下注射（SCIT），后来是舌下含服（SLIT）。在2013年进行回顾时，发现已发表的HDM免疫疗法研究通常具有样本量小、剂量差异大以及疾病严重程度和结局定义不明确的特点。这些试验被认为支持HDM皮下变应原免疫疗法的疗效，但舌下免疫疗法疗效的证据不太确凿。
本报告将回顾自2013年以来报道的大量设计良好的研究，其中大部分是关于SLIT的研究，特别是两种新开发的HDM舌下含片的研究。此外，还将探讨HDM免疫疗法的其他方面，包括在特应性皮炎中的应用、最佳治疗持续时间、疾病改善的证据以及与佐剂联合使用的情况。
自2013年系统评价的截止日期以来，共确定了17篇关于15项随机、双盲、安慰剂对照试验的报告。其中12篇报告了2种HDM SLIT片剂的结果。这些研究明确确定了这些片剂在治疗变应性鼻炎和哮喘方面的合适剂量、疗效和安全性。其他报告支持在特定的特应性皮炎患者中使用HDM免疫疗法，支持HDM免疫疗法给药3至5年，支持预计治疗3至5年后疾病改善，以及支持使用维生素D和特定益生菌来提高其疗效。
HDM SCIT和SLIT片剂疗法在变应性鼻炎和哮喘中已证明有效。尽管少数研究表明HDM SLIT液体制剂也可能有效，但尚未确定其合适剂量。HDM SCIT和HDM SLIT在变应性鼻炎和哮喘、疾病改善以及产生持久益处所需的治疗持续时间方面具有相同的疗效。
