淋巴结内特异性免疫治疗变应性鼻炎疗效和安全性的Meta分析

Intralymphatic immunotherapy for grass pollen-induced allergic rhinitis:A systematic review and meta-analysis of efficacy and safety

目的 系统评价淋巴结内特异性免疫治疗(ILIT)草花粉诱导的变应性鼻炎(AR)的临床疗效和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、CNKI、VIP等电子数据库,纳入诊断为草花粉诱导的AR患者,并接受淋巴结内免疫治疗的随机对照试验。主要结局包括症状评分、药物评分、症状和药物综合评分、视觉模拟量表。次要结局包括不良事件、生活质量、血清特异性IgE、血清特异性IgG4、皮肤点刺试验和鼻腔激发试验,采用RevMan 5.3软件进行Meta分析。结果 纳入9项研究269名受试者,所有研究都包括草花粉过敏原,其中5项研究还包括草和/或桦树花粉过敏原。除1项研究注射间隔时间为2周外,其余均为4周。与安慰剂对照组相比,ILIT组显著改善视觉模拟量表(P<0.05),而症状评分、药物评分、症状和药物综合评分、杜松鼻结膜炎生活质量问卷均显示差异无统计学意义(P均>0.05),其中症状和药物综合评分表现出中度异质性(I~2=60%)。每4周注射1次过敏原是改善症状和药物联合评分的最佳间隔时间,而加强注射或增加剂量是否能改善临床效果尚无定论。结论 Meta分析显示,ILIT总体上是安全的,但增加注射剂量可能出现严重并发症,应谨慎。ILIT对草花粉诱导的AR视觉模拟量表有显著改善,仍需要更大规模和更长期的试验来标准化治疗方案。ILIT可能在未来的AR治疗中发挥重要作用。

Objective To systematically evaluate the clinical efficacy and safety of intralymphatic immunotherapy(ILIT)for grass pollen-induced allergic rhinitis(AR).Methods Computer retrieval on electronic database from PubMed,Embase,Cochrane Library,CNKI and VIP were performed.Randomized clinical trials of ILIT in patients diagnosed with grass pollen-induced AR were included.Primary outcomes included symptoms score,medication score,combined symptoms and medication score and visual analog scale.Secondary outcomes included adverse events,quality of life,specific immunoglobulin E,specific immunoglobulin G4,skin prick test and nasal provocation test.Meta-analysis of symptom improvement was performed using RevMan 5.3 software.Results Nine trials included 269 participants were enrolled.All studies included grass pollen allergens and five also included grass and/or birch pollen allergens.The interval between injections was 4 weeks in all but one trial,which was 2 weeks.Compared to the placebo group,the ILIT group significantly improved the visual analog scale(P<0.05),whereas the symptom score,medication score,combined symptom and medication score,and the Juniper rhinoconjunctivitis quality-of-life questionnaire did not show statistically significant differences(all P>0.05),with the combined symptom and medication scores demonstrating moderate heterogeneity(I 2=60%).An allergen injection every 4 weeks was the optimal interval to improve combined symptoms and medication score.Whether a booster injection or escalating dose improved clinical effect was inconclusive.Conclusion ILIT is generally safe and well-tolerated.Escalating dose may cause serious complications and should be performed with caution.ILIT may make a significant improvement on visual analog scale in grass pollen-induced AR.Larger and longer-term trials are needed to standardize treatment options.ILIT may play an important role in the future treatment of AR.