舌下特异性免疫治疗在儿童变应性鼻炎中的疗效

The efficacy of sublingual specific immunotherapy in children with allergic rhinitis

目的：探讨单一变应原制剂舌下特异性免疫治疗（SLIT）在儿童变应性鼻炎（AR）患者中的疗效,并分析致敏状态与临床疗效的关系。方法：将130例4~15岁AR患儿随机分为SLIT组80例和对照组50例,患儿的临床症状主要由尘螨引起。SLIT组患儿均接受粉尘螨滴剂联合药物治疗1年,对照组患儿均接受药物治疗。每12周随访1次并评估患儿的鼻炎症状评分、对症用药评分、VAS评分及皮肤点刺试验结果。在研究结束后,根据过敏原数,将SLIT组患儿分为单一过敏组和多种过敏组进行分析。结果：SLIT组中有61例患儿、对照组有40例患儿完成1年的治疗。SLIT组与对照组患儿的鼻炎症状评分、对症用药评分和VAS评分在52周治疗后均显著减少（均P〈0.05）,SLIT组尘螨皮肤反应等级在52周治疗后下降（P〈0.05）,对照组尘螨皮肤反应等级治疗后与治疗前差异无统计学意义（P〉0.05）。组间比较,SLIT组鼻炎症状评分在24、36、52周均低于对照组,差异有统计学意义（均P〈0.05）。SLIT组对症用药评分和VAS评分在36、52周均低于对照组,差异有统计学意义（均P〈0.05）。SLIT组尘螨皮肤反应等级在52周低于对照组,差异有统计学意义（均P〈0.05）。单一过敏组、多种过敏组比较显示,除了在36周多种过敏组鼻炎症状评分低于单一过敏组（P〈0.05）和在24周多种过敏组VAS评分低于单一过敏组（P〈0.05）外,2组患儿在各次随访中的临床指标组间差异均无统计学意义（均P〉0.05）。结论：SLIT能够明显减轻鼻炎症状和药物使用,并改善患儿过敏体质。单一尘螨制剂SLIT治疗在多重过敏患者可以获得在单一过敏患者中同样的疗效,明显优于对症药物治疗。

Objective：To investigate the efficacy of single-allergen sublingual immunotherapy（SLIT）in children with allergic rhinitis and the potential relationship between sensitization status and efficacy and analyze the possible relationships between sensitized state and clinical efficacy.Method：One hundren and thirty children,aged4-15 years old,with mites-induced respiratory allergic diseases had been arranged into the treatment group（n=70）or control group（n=50）and received SLIT with standardized dermatophagoides farinae extracts and pharmacotherapy for 1year.Rhinitis and asthma symptoms and medications,visual analogue scale（VAS）,skin prick test（SPT）and peak expiratory flows（PEF）were evaluated.After treatment,patients in the poly-sensitized group who completed the study had been analyzed as subgroup 1（n=33）and subgroup 2（n=37）according to the number of coexist allergens.Result：The global clinical parameters had been significantly improved after treatment.The treatment and control group rhinitis symptom score,symptomatic medication score and VAS scores were significantly reduced after 52 weeks treatment（all P〈0.05）.SLIT group dust mite grade skin reactions decreased after52 weeks treatment（P〈0.05）.Dust mite skin reactions grade was greater than before treatment in the control group（P〉0.05）.Between the two groups,SLIT group rhinitis symptom score at 24 weeks,36weeks,52 weeks were lower than the control group,the difference was statistically significant（P〈0.05）.SLIT group symptomatic medication score and VAS scores at 36 weeks and 52 weeks compared with the control group,the difference was statistically significant（P〈0.05）.Dust mite SLIT group grade skin reactions grade was lower than the control group at 52 weeks,the difference was statistically significant（P〈0.05）.In addition to the 36 weeks poly-sensitized group symptoms of allergic rhinitis score was lower than mono-sensitized group（P〈0.05）and at 24 weeks poly-sensitized group VAS score was lower than single allergy group（P〈0.05）,the comparison between subgroup 1and subgroup 2indicated that,there was no significant difference in symptoms scores,SPT,PEF and VAS at each scheduled follow-up visit.Conclusion：This study shows that SLIT can significantly reduce rhinitis symptoms and drug use,and improve the children with allergies.An equivalent efficacy of single-allergen SLIT is found in poly-sensitized and mono-sensitized children.The number of coexist positive allergens has a limited impact on the efficacy from a long-term perspective.