
舌下特异性免疫治疗对尘螨过敏性哮喘儿童的作用
Efficacy of sublingual immunotherapy in children with dust mite allergic asthma
目的:观察舌下特异性免疫治疗(sublingual immunotherapy, SLIT)联合吸入糖皮质激素(inhaled corticosteroids, ICS)与单独ICS治疗尘螨过敏轻、中度哮喘儿童的临床疗效,为哮喘的联合治疗提供更多的选择方案。方法:对尘螨过敏的轻、中度哮喘患儿32例随机分为两组: SLIT组(SLIT联合ICS治疗,18例)和对照组(单独ICS治疗,14例)。两组共30例完成为期1年的临床观察。比较两组患儿ICS给药总量、哮喘日间和夜间症状评分、皮肤点刺试验、肺功能、血清sIgE和sIgG4值、VAS评分(visual analog scale)的差异。结果:SLIT组在1年治疗结束ICS给药总量较对照组显著减少;与对照组相比,SLIT组的日、夜间哮喘症状评分显著降低,肺功能FEF25- 75%值显著增加,sIgE值及VAS评分降低,差异有统计学意义(P<0.05);皮肤点刺反应计分、FEV1及sIgG4值两组差异无统计学意义(P>0.05)。在整个随访期两组均无严重不良反应。结论:SLIT联合ICS治疗在改善尘螨致敏哮喘患儿的日、夜间哮喘症状、肺功能及VAS评分方面的疗效优于单独使用ICS治疗。[中国当代儿科杂志,2010,12(5):344-347]
OBJECTIVE: To compare the efficacy of sublingual immunotherapy (SLIT) combined with inhaled corticosteroids (ICS) versus ICS alone in children with mild and moderate dust mite allergic asthma. METHODS: Thirty-two children with mild and moderate dust mite allergic asthma were randomly divided into two groups: SLIT+ICS (n=18) and ICS alone (n=14). A total of 30 children completed the one year clinical observation . The amount of ICS administration, the day and night symptom scores, skin-prick test and pulmonary function test results, serum specific immunoglobulin E (sIgE) and G4 (sIgG4) levels and visual analog scale (VAS) scores were compared between the two groups. RESULTS: By the end of one year the SLIT+ICS group had significantly decreased amount of ICS administration than the ICS alone group. Compared with the ICS alone group, the day and night symptom scores decreased, FEF25-75% increased significantly, and serum sIgE levels and VAS scores were significantly reduced in the SLIT+ICS group. There were no statistical differences in the skin-prick test results, and FEV1 and sIgG4 levels between the two groups. No severe adverse events occurred in both groups during the follow-up period. CONCLUSIONS: SLIT combined with ICS may produce a better efficacy than ICS alone in the improvement of day and night symptoms, pulmonary function and VAS scores in children with dust mite-allergic asthma.[Chin J Contemp Pediatr, 2010, 12 (5):344-347]
[1]Pocket Guide For Asthma Management and Prevention(updated 2008): Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA) [EB/OL]. http://www.ginasthma.org. April 11, 2008.
[2]HalloyJL. Sublingual hyposensitization[J]. Rev Med Brux, 2004, 25(4):A256-258.
[3]Abramson M, Puy R, Weiner J. Allergen immunotherapy for asthma[J]. Cochrane Database of Systematic Reviews, 2003, 4: CD001186.
[4]Di Rienzo V, Marcucci F, Puccinelli P, Parmiani S, Frati F, Sensi L, et al. Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective study[J].Clin Exp Allergy, 2003, 33(2): 206-210.
[5]Calamita Z, Saconato H, Pela AB, Atallah AN. Efficacy of sublingual immunotherapy in asthma: systematic review of randomized-clinical trials using the Cochrane Collaboration method[J]. Allergy, 2006, 61(10): 1162-1172.
[6]曹兰芳, 陆权, 顾洪亮, 陈燕萍, 张源, 陆敏,等. 舌下含服粉尘螨滴剂治疗儿童过敏性哮喘和变应性鼻炎的临床评价[J]. 中华儿科杂志, 2007, 45 (10) : 736-741.
[7]Penagos M, Passalacqua G, Compalati E, Baena-Cagnani CE, Orozco S, Pedroza A, et al. Meta analysis of the efficacy of sublingual immunotherapy in the treatment of allergic asthma in pediatric patients, 3 to 18 years of age[J]. Chest, 2008, 133(3):599-609.
[8]彭万胜,杨锡强,刘恩梅. 螨变应原舌下特异性免疫治疗螨致敏哮喘患儿疗效的Meta 分析[J].中国循证儿科杂志, 2009, 4(1):29-38.