It has always been controversial whether a single allergen performs better than multiple allergens in polysensitized patients during the allergen-specific immunotherapy. This study aimed to examine the clinical effica...It has always been controversial whether a single allergen performs better than multiple allergens in polysensitized patients during the allergen-specific immunotherapy. This study aimed to examine the clinical efficacy of single-allergen sublingual immunotherapy(SLIT) versus multi-allergen subcutaneous immunotherapy(SCIT) and to discover the change of the biomarker IL-4 after 1-year immunotherapy in polysensitized children aged 6–13 years with allergic rhinitis(AR) induced by house dust mites(HDMs). The AR polysensitized children(n=78) were randomly divided into two groups: SLIT group and SCIT group. Patients in the SLIT group sublingually received a single HDM extract and those in the SCIT group were subcutaneously given multiple-allergen extracts(HDM in combination with other clinically relevant allergen extracts). Before and 1 year after the allergen-specific immunotherapy(ASIT), the total nasal symptom scores(TNSS), total medication scores(TMS) and IL-4 levels in peripheral blood mononuclear cells(PBMCs) were compared respectively between the two groups. The results showed that the TNSS were greatly improved, and the TMS and IL-4 levels were significantly decreased after 1-year ASIT in both groups(SLIT group: P<0.001; SCIT group: P<0.001). There were no significant differences in any outcome measures between the two groups(for TNSS: P>0.05; for TMS: P>0.05; for IL-4 levels: P>0.05). It was concluded that the clinical efficacy of single-allergen SLIT is comparable with that of multi-allergen SCIT in 6–13-year-old children with HDM-induced AR.展开更多
This study examined the possible mechanism of sublingual immunotherapy（SLIT） in the treatment of allergic asthma.Forty asthma patients allergic to dust mite were enrolled.They received SLIT with dermatophagoides far...This study examined the possible mechanism of sublingual immunotherapy（SLIT） in the treatment of allergic asthma.Forty asthma patients allergic to dust mite were enrolled.They received SLIT with dermatophagoides farinae（Der.f） drops for one year.Thirty healthy subjects served as controls.The levels of IL-4 and IFN-γ of peripheral blood mononuclear cells（PBMCs） were determined in allergic asthma patients before and after the SLIT as well as the healthy subjects.The results showed that the level of IL-4 was substantially increased and that of IFN-γ remarkably decreased in the patients before the SLIT as compared with those in the healthy subjects（P0.05）.After the SLIT,the level of IL-4 was significantly reduced and that of IFN-γ elevated in these allergic asthma patients.It was concluded that sublingual immunotherapy is effective for patients with allergic asthma.And it may work by regulating the balance of Th1/Th2 through changing the expression of IL-4 and IFN-γ in PBMCs.展开更多
Allergic rhinitis affect 10%-20% of pediatric population and it is caused by the Ig E-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence pati...Allergic rhinitis affect 10%-20% of pediatric population and it is caused by the Ig E-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence patient's daily activity severely and may precede the development of asthma, especially if it is not diagnosed and treated correctly. In addition to subcutaneous immunotherapy, sublingual immunotherapy(SLIT) represents the only treatment being potentially able to cure allergic respiratory diseases, by modulating the immune system activity. This review clearly summarizes and analyzes the available randomized, double-blinded, placebo-controlled trials, which aimed at evaluating the effectiveness and the safety of grass pollen and house dust mite SLIT for the specific treatment of pediatric allergic rhinitis. Our analysis demonstrates the good evidence supporting the efficacy of SLIT for allergic rhinitis to grass pollens in children, whereas trials regarding pediatric allergic rhinitis to house dust mites present lower quality, although several studies supported its usefulness.展开更多
Though symptoms of allergic diseases can be reduced by the use of drugs such as corticosteroids, antihista-mines or leukotrien antagonists, the only treatment di-rected to change the natural course of allergic disease...Though symptoms of allergic diseases can be reduced by the use of drugs such as corticosteroids, antihista-mines or leukotrien antagonists, the only treatment di-rected to change the natural course of allergic disease is allergen-specific immunotherapy （SIT）. Its efficacy can last years after the cessassion of the treatment. SIT brings on regulatory T cells with the capacity to generate interleukin-10 and transforming growth fac-tor-b, restricts activation of mast cells and basophils, and shifts antibody isotype from IgE to the noninfam-matory type immunoglobulin G4. Subcutaneous （SCIT） and sublingual （SLIT） immunotherapy are the two most used ways at the present for applying SIT. These two treatments were demonstrated to be effective on re-ducing symptoms and medication use, in prevention of new sensitizations and in protecting from progression of rhinitis to asthma. The safety of SLIT appears to be better than SCIT although there have been a few head to head comparisons. In order to overcome compliance problems or possible systemic side effects which may be faced during this long-term treatment, recent inves-tigations have been focused on the implementation of allergens in quite effcacious and safer ways.展开更多
目的:观察舌下免疫治疗(SLIT)疗效与尘螨组分sIgE和sIgG4水平变化的相关性。方法:回顾性分析2018年4月~2021年10月就诊于某院过敏反应科并行SLIT的过敏性鼻炎患儿(n=37),根据治疗1年后症状和药物综合评分(CSMS)分为控制稳定组(n=25)和...目的:观察舌下免疫治疗(SLIT)疗效与尘螨组分sIgE和sIgG4水平变化的相关性。方法:回顾性分析2018年4月~2021年10月就诊于某院过敏反应科并行SLIT的过敏性鼻炎患儿(n=37),根据治疗1年后症状和药物综合评分(CSMS)分为控制稳定组(n=25)和控制不稳定组(n=12),比较两组患儿9种重要尘螨致敏蛋白组分(Derp1/Derf1、Derp2/Derf2、Derp5、Derp7、Derp10、Derp21和Derp23)sIgE和sIgG4的水平变化。结果:Derp1/Derf1和Derp2/Derf2为主要致敏蛋白组分,其治疗前sIgE阳性率为86.5%~94.6%,其中Der p 2的sIgE浓度高于Derp1(P<0.0001)、Derp5(P<0.001)、Derp7(P<0.001)、Derp10(P<0.001)、Derp21(P<0.01);Derf2的sIgE浓度高于Derf1(P<0.0001)、Derp5(P<0.0001)、Derp7(P<0.0001)、Der p 10(P<0.0001)、Der p 21(P<0.0001)和Der p 23(P<0.01)。治疗前Der f 2的sIgG4浓度高于其他组分(P<0.0001),控制不稳定组中Der f 1的sIgG4阳性率(33.3%)高于控制稳定组(4.0%,P<0.05),且控制不稳定组中Derf1和Derp10的sIgG4浓度高于控制稳定组(P<0.05)。治疗1年后,控制稳定组患儿Der f 1和Der p 2的sIgG4水平高于治疗前(P<0.05)。结论:尘螨致敏过敏性鼻炎患儿应用SLIT治疗后,Der f 1和Der p 2的sIgG4浓度升高明显,提示SLIT疗效较好,为临床评估SLIT疗效提供了线索。展开更多
Allergen-specific immunotherapy(SIT) induces clinical and immunological tolerance as defined by persistence of clinical benefit and associated long-term immunological parameters after cessation of treatment. Although ...Allergen-specific immunotherapy(SIT) induces clinical and immunological tolerance as defined by persistence of clinical benefit and associated long-term immunological parameters after cessation of treatment. Although the efficacy of SIT has been shown in terms of reducing symptoms, medication consumption and ameliorating quality of life in both allergic rhinitis and asthma, there has long been some controversies about effectiveness of SIT in the treatment of allergic asthma. The type of allergen, the dose and protocol of immunotherapy, patient selection criteria, the severity and control of asthma, all are significant contributors to the power of efficacy in allergic asthma. The initiation of SIT in allergic asthma should be considered in case of coexisting of other allergic diseases such as allergic rhinitis, unacceptable adverse effects of medications, patient's preference to avoid long-term pharmacotherapy. Steroid sparing effect of SIT in allergic asthma is also an important benefit particularly in patients who have to use these drugs in high doses for a long-time. Symptomatic asthma is a risk factor for systemic reactions and asthma should be controlled at the time of administration of SIT. Both subcutaneous immunotherapy(SCIT) and sublingual immunotherapy(SLIT) have been found to be effective in patients with allergic asthma. Although the safety profile of SLIT seems to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT may appear better and earlier than SLIT in children with allergic asthma.展开更多
<strong>Purpose:</strong> Allergen immunotherapy (AIT) while usually safe, is not without risk. Both sublingual (SLIT) and subcutaneous immunotherapy (SCIT) have the potential for systemic reactions includ...<strong>Purpose:</strong> Allergen immunotherapy (AIT) while usually safe, is not without risk. Both sublingual (SLIT) and subcutaneous immunotherapy (SCIT) have the potential for systemic reactions including anaphylaxis. <strong>Materials and Methods:</strong> A short survey was distributed to fellows of the American Academy of Otolaryngic Allergy (AAOA) (n = 553) in July of 2019 to determine current prescribing practices. <strong>Results:</strong> A total of 103/553 surveys were completed, giving a response rate of 18.6%. Prescribing patterns for SCIT showed 79.6% prescribed auto-injectable epinephrine (AIE) to all patients, 11.7% prescribed only to high risk patients, while 1.9% did not prescribe AIE at all. SLIT showed similar patterns with 71.8% prescribing AIE to all, 11.7% to high risk or letting patient choose, and 6.8% did not prescribe to anyone. Just under half of the physicians responded affirmatively to giving a written anaphylaxis plan to patients on immunotherapy. 48.5% physicians reported treating in-office anaphylaxis due to SCIT or skin testing in the past year, while 6% reported anaphylaxis due to SLIT. <strong>Conclusions:</strong> A majority of otolaryngic allergists are still prescribing AIE for both SCIT and SLIT. With the recent higher costs attributed to AIE as well as drug shortages, some physicians are risk-stratifying patients. While SCIT has a higher risk for treatment related systemic reactions, anaphylaxis does occur with SLIT, thus making it imperative to counsel patients on a clear anaphylaxis protocol in all forms of AIT.展开更多
文摘It has always been controversial whether a single allergen performs better than multiple allergens in polysensitized patients during the allergen-specific immunotherapy. This study aimed to examine the clinical efficacy of single-allergen sublingual immunotherapy(SLIT) versus multi-allergen subcutaneous immunotherapy(SCIT) and to discover the change of the biomarker IL-4 after 1-year immunotherapy in polysensitized children aged 6–13 years with allergic rhinitis(AR) induced by house dust mites(HDMs). The AR polysensitized children(n=78) were randomly divided into two groups: SLIT group and SCIT group. Patients in the SLIT group sublingually received a single HDM extract and those in the SCIT group were subcutaneously given multiple-allergen extracts(HDM in combination with other clinically relevant allergen extracts). Before and 1 year after the allergen-specific immunotherapy(ASIT), the total nasal symptom scores(TNSS), total medication scores(TMS) and IL-4 levels in peripheral blood mononuclear cells(PBMCs) were compared respectively between the two groups. The results showed that the TNSS were greatly improved, and the TMS and IL-4 levels were significantly decreased after 1-year ASIT in both groups(SLIT group: P<0.001; SCIT group: P<0.001). There were no significant differences in any outcome measures between the two groups(for TNSS: P>0.05; for TMS: P>0.05; for IL-4 levels: P>0.05). It was concluded that the clinical efficacy of single-allergen SLIT is comparable with that of multi-allergen SCIT in 6–13-year-old children with HDM-induced AR.
文摘This study examined the possible mechanism of sublingual immunotherapy（SLIT） in the treatment of allergic asthma.Forty asthma patients allergic to dust mite were enrolled.They received SLIT with dermatophagoides farinae（Der.f） drops for one year.Thirty healthy subjects served as controls.The levels of IL-4 and IFN-γ of peripheral blood mononuclear cells（PBMCs） were determined in allergic asthma patients before and after the SLIT as well as the healthy subjects.The results showed that the level of IL-4 was substantially increased and that of IFN-γ remarkably decreased in the patients before the SLIT as compared with those in the healthy subjects（P0.05）.After the SLIT,the level of IL-4 was significantly reduced and that of IFN-γ elevated in these allergic asthma patients.It was concluded that sublingual immunotherapy is effective for patients with allergic asthma.And it may work by regulating the balance of Th1/Th2 through changing the expression of IL-4 and IFN-γ in PBMCs.
文摘Allergic rhinitis affect 10%-20% of pediatric population and it is caused by the Ig E-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence patient's daily activity severely and may precede the development of asthma, especially if it is not diagnosed and treated correctly. In addition to subcutaneous immunotherapy, sublingual immunotherapy(SLIT) represents the only treatment being potentially able to cure allergic respiratory diseases, by modulating the immune system activity. This review clearly summarizes and analyzes the available randomized, double-blinded, placebo-controlled trials, which aimed at evaluating the effectiveness and the safety of grass pollen and house dust mite SLIT for the specific treatment of pediatric allergic rhinitis. Our analysis demonstrates the good evidence supporting the efficacy of SLIT for allergic rhinitis to grass pollens in children, whereas trials regarding pediatric allergic rhinitis to house dust mites present lower quality, although several studies supported its usefulness.
文摘Though symptoms of allergic diseases can be reduced by the use of drugs such as corticosteroids, antihista-mines or leukotrien antagonists, the only treatment di-rected to change the natural course of allergic disease is allergen-specific immunotherapy （SIT）. Its efficacy can last years after the cessassion of the treatment. SIT brings on regulatory T cells with the capacity to generate interleukin-10 and transforming growth fac-tor-b, restricts activation of mast cells and basophils, and shifts antibody isotype from IgE to the noninfam-matory type immunoglobulin G4. Subcutaneous （SCIT） and sublingual （SLIT） immunotherapy are the two most used ways at the present for applying SIT. These two treatments were demonstrated to be effective on re-ducing symptoms and medication use, in prevention of new sensitizations and in protecting from progression of rhinitis to asthma. The safety of SLIT appears to be better than SCIT although there have been a few head to head comparisons. In order to overcome compliance problems or possible systemic side effects which may be faced during this long-term treatment, recent inves-tigations have been focused on the implementation of allergens in quite effcacious and safer ways.
文摘目的:观察舌下免疫治疗(SLIT)疗效与尘螨组分sIgE和sIgG4水平变化的相关性。方法:回顾性分析2018年4月~2021年10月就诊于某院过敏反应科并行SLIT的过敏性鼻炎患儿(n=37),根据治疗1年后症状和药物综合评分(CSMS)分为控制稳定组(n=25)和控制不稳定组(n=12),比较两组患儿9种重要尘螨致敏蛋白组分(Derp1/Derf1、Derp2/Derf2、Derp5、Derp7、Derp10、Derp21和Derp23)sIgE和sIgG4的水平变化。结果:Derp1/Derf1和Derp2/Derf2为主要致敏蛋白组分,其治疗前sIgE阳性率为86.5%~94.6%,其中Der p 2的sIgE浓度高于Derp1(P<0.0001)、Derp5(P<0.001)、Derp7(P<0.001)、Derp10(P<0.001)、Derp21(P<0.01);Derf2的sIgE浓度高于Derf1(P<0.0001)、Derp5(P<0.0001)、Derp7(P<0.0001)、Der p 10(P<0.0001)、Der p 21(P<0.0001)和Der p 23(P<0.01)。治疗前Der f 2的sIgG4浓度高于其他组分(P<0.0001),控制不稳定组中Der f 1的sIgG4阳性率(33.3%)高于控制稳定组(4.0%,P<0.05),且控制不稳定组中Derf1和Derp10的sIgG4浓度高于控制稳定组(P<0.05)。治疗1年后,控制稳定组患儿Der f 1和Der p 2的sIgG4水平高于治疗前(P<0.05)。结论:尘螨致敏过敏性鼻炎患儿应用SLIT治疗后,Der f 1和Der p 2的sIgG4浓度升高明显,提示SLIT疗效较好,为临床评估SLIT疗效提供了线索。
文摘Allergen-specific immunotherapy(SIT) induces clinical and immunological tolerance as defined by persistence of clinical benefit and associated long-term immunological parameters after cessation of treatment. Although the efficacy of SIT has been shown in terms of reducing symptoms, medication consumption and ameliorating quality of life in both allergic rhinitis and asthma, there has long been some controversies about effectiveness of SIT in the treatment of allergic asthma. The type of allergen, the dose and protocol of immunotherapy, patient selection criteria, the severity and control of asthma, all are significant contributors to the power of efficacy in allergic asthma. The initiation of SIT in allergic asthma should be considered in case of coexisting of other allergic diseases such as allergic rhinitis, unacceptable adverse effects of medications, patient's preference to avoid long-term pharmacotherapy. Steroid sparing effect of SIT in allergic asthma is also an important benefit particularly in patients who have to use these drugs in high doses for a long-time. Symptomatic asthma is a risk factor for systemic reactions and asthma should be controlled at the time of administration of SIT. Both subcutaneous immunotherapy(SCIT) and sublingual immunotherapy(SLIT) have been found to be effective in patients with allergic asthma. Although the safety profile of SLIT seems to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT may appear better and earlier than SLIT in children with allergic asthma.
文摘<strong>Purpose:</strong> Allergen immunotherapy (AIT) while usually safe, is not without risk. Both sublingual (SLIT) and subcutaneous immunotherapy (SCIT) have the potential for systemic reactions including anaphylaxis. <strong>Materials and Methods:</strong> A short survey was distributed to fellows of the American Academy of Otolaryngic Allergy (AAOA) (n = 553) in July of 2019 to determine current prescribing practices. <strong>Results:</strong> A total of 103/553 surveys were completed, giving a response rate of 18.6%. Prescribing patterns for SCIT showed 79.6% prescribed auto-injectable epinephrine (AIE) to all patients, 11.7% prescribed only to high risk patients, while 1.9% did not prescribe AIE at all. SLIT showed similar patterns with 71.8% prescribing AIE to all, 11.7% to high risk or letting patient choose, and 6.8% did not prescribe to anyone. Just under half of the physicians responded affirmatively to giving a written anaphylaxis plan to patients on immunotherapy. 48.5% physicians reported treating in-office anaphylaxis due to SCIT or skin testing in the past year, while 6% reported anaphylaxis due to SLIT. <strong>Conclusions:</strong> A majority of otolaryngic allergists are still prescribing AIE for both SCIT and SLIT. With the recent higher costs attributed to AIE as well as drug shortages, some physicians are risk-stratifying patients. While SCIT has a higher risk for treatment related systemic reactions, anaphylaxis does occur with SLIT, thus making it imperative to counsel patients on a clear anaphylaxis protocol in all forms of AIT.
