变应原特异性免疫治疗特应性皮炎的进展

Application of allergen-specific immunotherapy in atopie dermatitis

特应性皮炎作为一种过敏性皮肤病，变应原在其发病过程中起重要作用，变应原特异性免疫治疗通过多次、小剂量接触变应原，诱导机体产生免疫耐受，针对病因治疗是改变过敏性疾病进程唯一有效的方法。目前变应原特异性免疫治疗已广泛应用于过敏性疾病，但由于对治疗方法认识的不足及缺乏大样本临床数据的肯定，对特应性皮炎的治疗仍有争议，较为被接受的是皮下注射和舌下含服。近几年研究发现，单克隆抗体联合免疫治疗，可提高免疫治疗的安全性，新的给药途径如淋巴结注射免疫治疗和经皮免疫治疗，以及新的治疗方案（快速变应原特异性免疫治疗和集群变应原特异性免疫治疗）可有效治疗特应性皮炎，且不增加不良反应发生率，而建立在食物过敏基础上的变应原特异性免疫治疗尚有争议。

Atopic dermatitis （AD） is a kind of allergic skin diseases, and allergens play important roles in the pathogenesis of AD. Allergen？specific immunotherapy （ASIT） can induce immune tolerance through repeated contact with low？dose allergens, and is considered to be the only effective way to change the course of allergic diseases. At present, ASIT has been widely applied to the treatment of allergic diseases, but its application is still controversial in AD due to insufficient understanding on this therapy and lack of evidences from large sample？sized clinical trials. Currently, subcutaneous injection immunotherapy （SCIT） and sublingual immunotherapy （SLIT） have been accepted. Recent studies have found that the combination with monoclonal antibody？based treatment can improve the safety of desensitization treatment. New therapeutic methods such as intralymphatic immunotherapy, transcutaneous immunotherapy, rush ASIT and cluster ASIT, have been developed and proved to be effective for the treatment of AD with no increase in the incidence of adverse reactions. However, ASIT based on food allergy is still controversial.