JAMA：舌下免疫疗法能用于过敏性鼻炎和哮喘的治疗

    据3月27日发表在《美国医学会杂志》JAMA上的一则研究披露，在一项对一种针对过敏性鼻炎和哮喘的疗法所做的检查中，研究人员在先前的研究中发现了适度的证据以支持用舌下免疫疗法来治疗这些疾病的做法，该疗法在欧洲已经获得使用但却没有在美国获得美国食品与药物管理局的批准。舌下免疫疗法涉及在一个较长的治疗期内在舌下给予水溶性过敏原并通过局部吸收使过敏个体脱敏以减少其过敏症状。

    过敏性鼻炎（这是一种症状类似感冒的过敏反应）影响到大约20-40%的美国人口。人们对用舌下免疫疗法治疗过敏性鼻炎表现出了相当大的兴趣。与皮下（皮肤下）免疫疗法相比，舌下免疫疗法容易进行，不需要注射，而且患者可在家中而不必前往诊所进行治疗。

    巴尔的摩约翰霍普金斯大学医学院的Sandra Y. Lin， M.D.及其同事对以往的研究开展了一项系统性的回顾，旨在检查用水溶性舌下免疫疗法治疗过敏性鼻结膜炎和哮喘的有效性和安全性。在对医学文献进行审阅之后，研究人员确认了有5131名参与者的63项研究符合进行综述的纳入标准。参与者的年龄范围在4-74岁之间。有20项研究（n=1，814位患者）仅包括儿童患者。

    研究人员发现有很强的证据支持舌下免疫疗法可改善哮喘症状，13项研究中有8项报告了患者的改善幅度与对照组相比要高出40%以上。

    文章的作者得出结论：“我们的审查发现了适度的证据以支持用舌下免疫疗法来治疗过敏性鼻炎和哮喘的做法。这表明了适度的可信性，即这些证据反映了真正的功效。然而，未来的研究可能会改变这一估计。研究人员需要开展高品质的研究来回答有关最佳给药策略的问题。”

Sublingual Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and Asthma A Systematic Review

Sandra Y. Lin, MD; Nkiruka Erekosima, MD, MPH; Julia M. Kim, MD, MPH; Murugappan Ramanathan, MD; Catalina Suarez-Cuervo, MD; Yohalakshmi Chelladurai, MBBS; Darcy Ward, BA; Jodi B. Segal, MD, MPH

Importance Allergic rhinitis affects up to 40% of the US population. To desensitize allergic individuals, subcutaneous injection immunotherapy or sublingual immunotherapy may be administered. In the United States, sublingual immunotherapy is not approved by the Food and Drug Administration. However, some US physicians use aqueous allergens, off-label, for sublingual desensitization. Objective To systematically review the effectiveness and safety of aqueous sublingual immunotherapy for allergic rhinoconjunctivitis and asthma. Evidence Acquisition The databases of MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials were searched through December 22, 2012. English-language randomized controlled trials were included if they compared sublingual immunotherapy with placebo, pharmacotherapy, or other sublingual immunotherapy regimens and reported clinical outcomes. Studies of sublingual immunotherapy that are unavailable in the United States and for which a related immunotherapy is unavailable in the United States were excluded. Paired reviewers selected articles and extracted the data. The strength of the evidence for each comparison and outcome was graded based on the risk of bias (scored on allocation, concealment of intervention, incomplete data, sponsor company involvement, and other bias), consistency, magnitude of effect, and the directness of the evidence. Results Sixty-three studies with 5131 participants met the inclusion criteria. Participants' ages ranged from 4 to 74 years. Twenty studies (n = 1814 patients) enrolled only children. The risk of bias was medium in 43 studies (68%). Strong evidence supports that sublingual immunotherapy improves asthma symptoms, with 8 of 13 studies reporting greater than 40% improvement vs the comparator. Moderate evidence supports that sublingual immunotherapy use decreases rhinitis or rhinoconjunctivitis symptoms, with 9 of 36 studies demonstrating greater than 40% improvement vs the comparator. Medication use for asthma and allergies decreased by more than 40% in 16 of 41 studies of sublingual immunotherapy with moderate grade evidence. Moderate evidence supports that sublingual immunotherapy improves conjunctivitis symptoms (13 studies), combined symptom and medication scores (20 studies), and disease-specific quality of life (8 studies). Local reactions were frequent, but anaphylaxis was not reported. Conclusions and Relevance The overall evidence provides a moderate grade level of evidence to support the effectiveness of sublingual immunotherapy for the treatment of allergic rhinitis and asthma, but high-quality studies are still needed to answer questions regarding optimal dosing strategies. There were limitations in the standardization of adverse events reporting, but no life-threatening adverse events were noted in this review.

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