The Department of Otolaryngology-Head and Neck Surgery, Nanchong Central Hospital, Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, China.
Front Immunol. 2023 Dec 15;14:1274241. doi: 10.3389/fimmu.2023.1274241. eCollection 2023.
To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR).
PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2, 2023. Outcomes included symptom scores (SSs), medication scores (MSs), symptom and medication scores (SMSs), new sensitizations, development of asthma, improvement, and treatment-related adverse events (TRAEs). The quality of the included studies was assessed by the modified Jadad scale and Newcastle-Ottawa scale (NOS). Meta-regression was carried out to explore the source of heterogeneity. Subgroup analysis was further conducted in terms of study design [randomized controlled trials (RCTs), cohort studies], allergen [house dust mites (HDMs), grass pollen], treatment duration (≥ 24, 12-23 or < 12 months), allergen immunotherapy (AIT) modality (drops or tablets), and AIT protocol [continuous, pre-seasonal, co-seasonal, or after the grass pollen season (GPS)]. Sensitivity analysis was conducted for all outcomes. A Bayesian framework and a Monte Carlo Markov Chain (MCMC) model were developed for indirect comparison.
Totally 50 studies with 10813 AR children were included, with 4122 treated with SLIT, 1852 treated with SCIT, and 4839 treated with non-SLIT or non-SCIT therapy. For direct comparison, the SLIT group had a similar SS to the SCIT group [pooled standardized mean difference (SMD): 0.41, 95% confidence interval (CI): -0.46, 1.28, = 0.353]. Comparable MSs were observed in the SLIT and SCIT groups (pooled SMD: 0.82, 95%CI: -0.88, 2.53, = 0.344). For indirect comparison, no significant differences were found in SSs (pooled SMD: 1.20, 95% credibility interval (CrI): -1.70, 4.10), MSs (pooled SMD: 0.57, 95%CrI: -1.20, 2.30), SMSs (pooled SMD: 1.80, 95%CrI: -0.005, 3.60), new sensitizations [pooled relative risk (RR): 0.34, 95%CrI: 0.03, 3.58], and development of asthma (pooled RR: 0.68, 95%CrI: 0.01, 26.33) between the SLIT and SCIT groups; the SLIT group illustrated a significantly lower incidence of TRAEs than the SCIT group (pooled RR: 0.17, 95%CrI: 0.11, 0.26).
Considering both efficacy and safety, SLIT might be a more favorable AIT than SCIT in the treatment of pediatric AR, which may serve as a decision-making reference for clinicians.
PROSPERO (CRD42023460693).
系统比较皮下免疫疗法（SCIT）和舌下免疫疗法（SLIT）在儿童变应性鼻炎（AR）中的疗效和安全性。
检索 PubMed、Embase、Cochrane 图书馆和 Web of Science 从建库至 2023 年 3 月 2 日的数据。结局指标包括症状评分（SSs）、用药评分（MSs）、症状和用药评分（SMSs）、新致敏、哮喘发展、改善和与治疗相关的不良事件（TRAEs）。采用改良 Jadad 量表和 Newcastle-Ottawa 量表（NOS）评估纳入研究的质量。采用元回归分析探索异质性的来源。进一步根据研究设计（随机对照试验 [RCTs]、队列研究）、过敏原（屋尘螨 [HDM]、草花粉）、治疗持续时间（≥24、12-23 或＜12 个月）、过敏原免疫疗法（AIT）方式（滴剂或片剂）和 AIT 方案（连续、预季节、共季节或草花粉季后 [GPS]）进行亚组分析。对所有结局指标进行敏感性分析。采用贝叶斯框架和蒙特卡罗马尔可夫链（MCMC）模型进行间接比较。
共纳入 50 项研究，涉及 10813 例 AR 儿童，其中 4122 例接受 SLIT 治疗，1852 例接受 SCIT 治疗，4839 例接受非 SLIT 或非 SCIT 治疗。对于直接比较，SLIT 组与 SCIT 组的 SS 相似[汇总标准化均数差（SMD）：0.41，95%置信区间（CI）：-0.46，1.28， = 0.353]。SLIT 组和 SCIT 组的 MS 相似（汇总 SMD：0.82，95%CI：-0.88，2.53， = 0.344）。对于间接比较，SS 无显著差异（汇总 SMD：1.20，95%可信区间 [CrI]：-1.70，4.10）、MS 无显著差异（汇总 SMD：0.57，95%CrI：-1.20，2.30）、SMS 无显著差异（汇总 SMD：1.80，95%CrI：-0.005，3.60）、新致敏无显著差异[汇总相对风险（RR）：0.34，95%CrI：0.03，3.58]和哮喘发展无显著差异（汇总 RR：0.68，95%CrI：0.01，26.33），SLIT 组和 SCIT 组之间；SLIT 组的 TRAE 发生率明显低于 SCIT 组（汇总 RR：0.17，95%CrI：0.11，0.26）。
考虑到疗效和安全性，SLIT 可能是治疗儿童 AR 比 SCIT 更有利的 AIT，可为临床医生提供决策参考。
PROSPERO（CRD42023460693）。
