Rhyou Hyo In, Nam Young Hee
Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea.
Allergy Asthma Immunol Res. 2020 Jan;12(1):99-109. doi: 10.4168/aair.2020.12.1.99.
Allergen immunotherapy (AIT) induces immunological tolerance, and there is increasing evidence of the clinical efficacy of AIT in the treatment of allergic asthma. However, the optimal parameters for asthma control in clinical trials are still unclear. We investigated the efficacy of AIT with respect to changes in the inhaled corticosteroid (ICS) dose in patients with allergic asthma.
A total of 117 adults with allergic asthma who had used ICS for more than 1 year in a single tertiary hospital in Korea were included in this retrospective study. We compared the clinical parameters and outcomes between the AIT group (ICS with AIT, n = 48) and the non-AIT group (ICS without AIT, n = 69) by applying an inverse probability of treatment weighting method. The patients in the AIT group had received subcutaneous AIT monthly as a maintenance treatment for more than 1 year. The changes in the ICS dose from baseline were evaluated in the 2 groups for 3 years.
The proportion of responders who discontinued or decreased in the ICS dose with achieving control status of asthma was significantly higher in the AIT group than in the non-AIT group throughout the study period (at 6 months, 52.1% . 24.6%; at 1 year, 70.8% . 34.7%; at 2 years, 89.5% . 35.6%; at 3 years, 96.3% . 51.2%). Treatment responses did not differ significantly by type of allergen (single- or multi-allergens or 3 different products) used throughout the study period.
Irrespective of the type of allergen, long-term maintenance AIT helps to spare ICS dose and achieve better control in patients with allergic asthma in real-world clinical practice.
变应原免疫疗法（AIT）可诱导免疫耐受，并且越来越多的证据表明AIT在治疗过敏性哮喘方面具有临床疗效。然而，临床试验中哮喘控制的最佳参数仍不明确。我们研究了AIT对过敏性哮喘患者吸入性糖皮质激素（ICS）剂量变化的疗效。
本回顾性研究纳入了韩国一家三级医院中117名使用ICS超过1年的成年过敏性哮喘患者。我们采用治疗权重逆概率法比较了AIT组（ICS联合AIT，n = 48）和非AIT组（仅使用ICS，n = 69）的临床参数和结局。AIT组患者每月接受皮下AIT作为维持治疗超过1年。对两组患者3年内ICS剂量相对于基线的变化进行了评估。
在整个研究期间，达到哮喘控制状态且停用或降低ICS剂量的缓解者比例在AIT组显著高于非AIT组（6个月时，52.1%对24.6%；1年时，70.8%对34.7%；2年时，89.5%对35.6%；3年时，96.3%对51.2%）。在整个研究期间，使用的变应原类型（单一或多种变应原或3种不同产品）对治疗反应没有显著差异。
在真实世界的临床实践中，无论变应原类型如何，长期维持AIT有助于节省ICS剂量并使过敏性哮喘患者获得更好的控制。
