Meerwein Christian M, Sacks Peta-Lee, Ho Jacqueline, Choy Christine, Kalish Larry, Campbell Raewyn G, Sacks Ray R, Harvey Richard J
Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
Department of Otorhinolaryngology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Int Forum Allergy Rhinol. 2025 Feb;15(2):128-134. doi: 10.1002/alr.23459. Epub 2024 Sep 27.
To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post-surgery.
A retrospective cohort of surgically treated, HDM-sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22-item sino-nasal outcome test (SNOT-22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin-exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell × 10/L), tissue eosinophilia (% > 100/HPF), and serum IgE (kU/L) were also recorded.
Eighty-six CCAD patients were assessed (41 ± 14 yrs, 64% female). AIT was applied in 37% (n = 32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p = 0.02) in the AIT group. At 12 months post-surgery, the AIT group has less MT edema (% ≥ diffuse 15.6 vs. 52.9, p < 0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (% ≥ 4/week, 37.5 vs. 79.6%, p < 0.01). The rhinologic symptoms were similar (21.1 ± 17.1 vs. 20.1 ± 21.6, p = 0.83).
Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de-escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation.
评估变应原免疫疗法（AIT）对中央隔室特应性疾病（CCAD）且术后对屋尘螨（HDM）致敏患者的疗效。
对一组经手术治疗、对HDM致敏且表型为CCAD的慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者进行回顾性队列研究。根据患者在手术治疗过程中是否开始接受AIT，将其分为两组。所有接受AIT的患者在手术前开始免疫治疗。主要终点是术后12个月中鼻甲（MT）水肿的恢复情况。次要终点是皮质类固醇冲洗的使用情况（<4次/周与≥4次/周，%）以及22项鼻-鼻窦结局测试（SNOT-22）的鼻科领域得分。还记录了人口统计学特征、合并哮喘、吸烟状况、阿司匹林诱发的呼吸道疾病史、结膜症状、多致敏情况、血清嗜酸性粒细胞（细胞×10/L）、组织嗜酸性粒细胞增多（%>100/HPF）以及血清IgE（kU/L）。
评估了86例CCAD患者（41±14岁，64%为女性）。37%（n = 32）的患者接受了AIT。除AIT组结膜症状更明显（72%对45%，p = 0.02）外，两组基线特征相似。术后12个月时，AIT组MT水肿较轻（%≥弥漫性15.6对52.9，p < 0.01）。接受AIT的患者在12个月时药物治疗需求也较少（%≥4/周，37.5%对79.6%，p < 0.01）。鼻科症状相似（21.1±17.1对20.1±21.6，p = 0.83）。
手术和药物治疗对CCAD有效，但加用AIT可改善过敏现象并减少局部治疗的用量。需要进行长期研究以证明进一步的免疫调节作用。
