Sayed Khulood M, Kamel Ahmed G, Ali Abdellah H
Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag, 82524, Egypt.
Department of Respiratory Medicine, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
Graefes Arch Clin Exp Ophthalmol. 2019 Sep;257(9):1989-1996. doi: 10.1007/s00417-019-04389-w. Epub 2019 Jun 17.
The aim of this study is to evaluate the clinical and immunological efficacy and safety of allergen immunotherapy (AIT) in patients with allergic conjunctivitis (AC) and to compare between sublingual and subcutaneous routes of administration.
A prospective comparative case series study was performed on 100 patients with IgE-mediated AC. Patients were referred to allergy clinics for skin prick test (SPT) and AIT. Patients with positive SPT and high-serum IgE level were enrolled in this study. Patients were divided into two groups: sublingual immunotherapy (SLIT) group (50 patients) and subcutaneous immunotherapy (SCIT) group (50 patients). Both groups were followed for 1 year. Efficacy was assessed clinically by comparing pre- and post-treatment symptoms and medication scores and assessed immunologically by comparing pre- and post-treatment serum IgE level and wheal diameter of SPT. Safety of the therapy was assessed by the occurrence of adverse reactions and patient tolerability to the therapy.
Patients were either mono- or polysensitized to different allergens. Aeroallergens were significantly more common than food allergens (P = 0.00). The most prevalent aeroallergens were pollens (40%) and house dust (30%). At 12-month follow-up, both routes SLIT and SCIT led to a statistically significant clinical and immunological improvement (P < 0.05). This improvement was evident in all follow-up parameters including total ocular symptom score (TOSS), medication score, total serum IgE level, and wheal diameter of skin prick test (SPT). There was no significant difference between the two routes of administration (SLIT & SCIT) in any of the follow-up parameters (P > 0.05). Patients were able to tolerate the allergen therapy without developing any serious adverse events.
Aeroallergen polysensitization is common among patients with AC. SPT should be included in the diagnostic workup of those patients. AIT is a safe and effective treatment option for patients with AC as it has the potential to achieve significant reduction in symptom and medication scores without ocular or systemic side effects. There is no significant difference between both routes of administration either SLIT or SCIT in achieving clinical and immunologic improvement; so the patient can choose his preferred method for therapy.
本研究旨在评估变应原免疫疗法（AIT）对过敏性结膜炎（AC）患者的临床和免疫疗效及安全性，并比较舌下给药和皮下给药途径。
对100例IgE介导的AC患者进行前瞻性比较病例系列研究。患者被转诊至过敏诊所进行皮肤点刺试验（SPT）和AIT。SPT阳性且血清IgE水平高的患者纳入本研究。患者分为两组：舌下免疫疗法（SLIT）组（50例患者）和皮下免疫疗法（SCIT）组（50例患者）。两组均随访1年。通过比较治疗前后的症状和用药评分进行临床疗效评估，通过比较治疗前后的血清IgE水平和SPT风团直径进行免疫疗效评估。通过不良反应的发生情况和患者对治疗的耐受性评估治疗的安全性。
患者对不同变应原存在单敏或多敏情况。气传变应原比食物变应原更为常见（P = 0.00）。最常见的气传变应原是花粉（40%）和屋尘（30%）。在12个月的随访中，SLIT和SCIT两种途径均导致临床和免疫方面有统计学意义的改善（P < 0.05）。这种改善在所有随访参数中均很明显，包括总眼部症状评分（TOSS）、用药评分、血清总IgE水平和皮肤点刺试验（SPT）的风团直径。在任何随访参数中，两种给药途径（SLIT和SCIT）之间均无显著差异（P > 0.05）。患者能够耐受变应原治疗，未发生任何严重不良事件。
气传变应原多敏在AC患者中很常见。这些患者的诊断检查应包括SPT。AIT是AC患者一种安全有效的治疗选择，因为它有可能显著降低症状和用药评分，且无眼部或全身副作用。在实现临床和免疫改善方面，SLIT或SCIT两种给药途径之间无显著差异；因此患者可选择其偏好的治疗方法。
