Creticos P S, Reed C E, Norman P S, Khoury J, Adkinson N F, Buncher C R, Busse W W, Bush R K, Gadde J, Li J T
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
N Engl J Med. 1996 Feb 22;334(8):501-6. doi: 10.1056/NEJM199602223340804.
Although allergen immunotherapy is effective for allergic rhinitis, its role in treating asthma is unclear.
We examined the efficacy of immunotherapy for asthma exacerbated by seasonal ragweed exposure. During an observation phase, adults with asthma who were sensitive to ragweed kept daily diaries and recorded peak expiratory flow rates between July and October. Those who reported seasonal asthma symptoms and medication use as well as decreased peak expiratory flow were randomly assigned to receive placebo or ragweed-extract immunotherapy in doses that increased weekly for an additional two years.
During the observation phase, the mean (+/- SE) peak expiratory flow rate measured in the morning during the three weeks representing the height of the pollination season was 454 +/- 20 liters per minute in the immunotherapy group and 444 +/- 16 liters per minute in the placebo group. Of the 77 patients who began the treatment phase, 64 completed one year of the study treatment and 53 completed two years. During the two treatment years, the mean peak expiratory flow rate was higher in the immunotherapy group (489 +/- 16 liters per minute, vs. 453 +/- 17 in the placebo group [P = 0.06] during the first year, and 480 +/- 12 liters per minute, vs. 461 +/- 13 in the placebo group [P = 0.03] during the second). Medication use was higher in the immunotherapy group than in the placebo group during observation and lower during the first treatment year (P = 0.01) but did not differ in the two groups during the second year (P = 0.7). Asthma-symptom scores were similar in the two groups (P = 0.08 in year 1 and P = 0.3 in year 2). The immunotherapy group had reduced hay-fever symptoms, skin-test sensitivity to ragweed, and sensitivity to bronchial challenges and increased IgG antibodies to ragweed as compared with the placebo group; there was no longer a seasonal increase in IgE antibodies to ragweed allergen in the immunotherapy group after two years of treatment. Reduced medication costs were counterbalanced by the costs of immunotherapy.
Although immunotherapy for adults with asthma exacerbated by seasonal ragweed exposure had positive effects on objective measures of asthma and allergy, the clinical effects were limited and many were not sustained for two years.
尽管变应原免疫疗法对过敏性鼻炎有效，但其在治疗哮喘中的作用尚不清楚。
我们研究了免疫疗法对因季节性豚草暴露而加重的哮喘的疗效。在观察阶段，对豚草敏感的成年哮喘患者每天记日记，并记录7月至10月期间的呼气峰值流速。那些报告有季节性哮喘症状、使用药物以及呼气峰值流速降低的患者被随机分配接受安慰剂或豚草提取物免疫疗法，剂量每周增加，持续另外两年。
在观察阶段，在代表授粉季节高峰期的三周内，免疫疗法组早晨测得的平均（±标准误）呼气峰值流速为每分钟454±20升，安慰剂组为每分钟444±16升。在开始治疗阶段的77名患者中，64名完成了一年的研究治疗，53名完成了两年的治疗。在两个治疗年中，免疫疗法组的平均呼气峰值流速较高（第一年为每分钟489±16升，安慰剂组为453±17升[P = 0.06]；第二年为每分钟480±12升，安慰剂组为461±13升[P = 0.03]）。在观察期间，免疫疗法组的药物使用量高于安慰剂组，在第一个治疗年较低（P = 0.01），但在第二年两组无差异（P = 0.7）。两组的哮喘症状评分相似（第一年P = 0.08，第二年P = 0.3）。与安慰剂组相比，免疫疗法组的花粉热症状、对豚草的皮肤试验敏感性以及对支气管激发的敏感性降低，对豚草的IgG抗体增加；治疗两年后，免疫疗法组中针对豚草变应原的IgE抗体不再有季节性增加。免疫疗法的费用抵消了降低的药物成本。
尽管对因季节性豚草暴露而加重的成年哮喘患者进行免疫疗法对哮喘和过敏的客观指标有积极影响，但临床效果有限，且许多效果在两年内未持续。
