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
目的良好的患者依从率是保证变应原特异性免疫治疗的关键,本研究系统评价变应原皮下特异性免疫治疗(皮下脱敏治疗)患者的依从率及影响因素。方法检索PubMed、Cochrane library、Web of Science、CINAHL,中国生物医学文献数据库(CBM)、...目的良好的患者依从率是保证变应原特异性免疫治疗的关键,本研究系统评价变应原皮下特异性免疫治疗(皮下脱敏治疗)患者的依从率及影响因素。方法检索PubMed、Cochrane library、Web of Science、CINAHL,中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据知识服务平台和维普(VIP)数据库,检索时限为建库至2023年8月。采用澳大利亚JBI循证卫生保健中心研究真实性评价标准进行文献评价。采用Revman5.3版软件对皮下脱敏治疗依从率进行Meta分析,对影响依从率的因素采用描述性分析。结果共纳入符合条件的文献28篇,结果显示皮下特异性免疫治疗依从率在23.00%~91.46%之间,合并依从率为67.00%(95%CI:57.00%~77.00%);影响依从率的主要因素包括药物不良反应(1.40%~29.00%)、治疗效果未达预期(2.60%~44.00%)、症状改善(4.00%~60.60%)、经济原因(1.00%~47.90%)等;儿童患者的依从率明显高于成人(OR=0.53,95%CI:0.47~0.61,P<0.000)。结论皮下脱敏治疗的总体依从率偏低,且影响依从率的因素较多,采取个性化措施增加患者依从率是提高皮下脱敏治疗的关键。展开更多
目的构建过敏性哮喘患儿接受螨皮下注射免疫治疗(SCIT)出现不良反应的诺莫图预测模型,并加以评估和验证。方法回顾性分析2016年8月至2023年12月于天津医科大学第二医院儿科接受螨SCIT的过敏性哮喘患儿的病历资料。根据SCIT初始治疗阶段...目的构建过敏性哮喘患儿接受螨皮下注射免疫治疗(SCIT)出现不良反应的诺莫图预测模型,并加以评估和验证。方法回顾性分析2016年8月至2023年12月于天津医科大学第二医院儿科接受螨SCIT的过敏性哮喘患儿的病历资料。根据SCIT初始治疗阶段出现不良反应情况将其分为不良反应组和无不良反应组,2组共同组成建模组。通过单因素和多因素Logistic回归分析筛选独立危险因素,构建预测模型,绘制诺莫图,并对模型进行评估和验证。结果共纳入350例患儿,不良反应组176例,无不良反应组174例。对患儿的基线资料进行单因素Logistic回归分析,结果显示,性别、年龄、近1年哮喘急性发作次数、嗜酸性粒细胞百分比(EOS%)、第一秒用力呼气容积占预计值百分比(FEV1%pred)、总IgE(tIgE)、屋尘螨(Der p)特异性IgE(sIgE)、粉尘螨(Der f)sIgE、其他吸入性过敏原种类数是SCIT不良反应发生的危险因素(均P<0.1)。将其纳入多因素Logistic回归分析,结果显示,年龄、近1年哮喘急性发作次数、tIgE、Der p sIgE、Der f sIgE、其他吸入性过敏原种类数是独立危险因素(P均<0.05),基于此结果绘制诺莫图。绘制受试者操作特征曲线进行模型评价,曲线下面积为0.877(灵敏度73.9%,特异度90.8%),且预测概率与实际发生概率一致性较好,内部验证表明该模型具有较好的预测效能。结论年龄、近1年哮喘急性发作次数、tIgE、Der p sIgE、Der f sIgE、其他吸入性过敏原种类数为儿童螨SCIT不良反应的独立危险因素,基于此绘制的诺莫图具有较好的预测价值。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.
文摘目的良好的患者依从率是保证变应原特异性免疫治疗的关键,本研究系统评价变应原皮下特异性免疫治疗(皮下脱敏治疗)患者的依从率及影响因素。方法检索PubMed、Cochrane library、Web of Science、CINAHL,中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据知识服务平台和维普(VIP)数据库,检索时限为建库至2023年8月。采用澳大利亚JBI循证卫生保健中心研究真实性评价标准进行文献评价。采用Revman5.3版软件对皮下脱敏治疗依从率进行Meta分析,对影响依从率的因素采用描述性分析。结果共纳入符合条件的文献28篇,结果显示皮下特异性免疫治疗依从率在23.00%~91.46%之间,合并依从率为67.00%(95%CI:57.00%~77.00%);影响依从率的主要因素包括药物不良反应(1.40%~29.00%)、治疗效果未达预期(2.60%~44.00%)、症状改善(4.00%~60.60%)、经济原因(1.00%~47.90%)等;儿童患者的依从率明显高于成人(OR=0.53,95%CI:0.47~0.61,P<0.000)。结论皮下脱敏治疗的总体依从率偏低,且影响依从率的因素较多,采取个性化措施增加患者依从率是提高皮下脱敏治疗的关键。
文摘目的构建过敏性哮喘患儿接受螨皮下注射免疫治疗(SCIT)出现不良反应的诺莫图预测模型,并加以评估和验证。方法回顾性分析2016年8月至2023年12月于天津医科大学第二医院儿科接受螨SCIT的过敏性哮喘患儿的病历资料。根据SCIT初始治疗阶段出现不良反应情况将其分为不良反应组和无不良反应组,2组共同组成建模组。通过单因素和多因素Logistic回归分析筛选独立危险因素,构建预测模型,绘制诺莫图,并对模型进行评估和验证。结果共纳入350例患儿,不良反应组176例,无不良反应组174例。对患儿的基线资料进行单因素Logistic回归分析,结果显示,性别、年龄、近1年哮喘急性发作次数、嗜酸性粒细胞百分比(EOS%)、第一秒用力呼气容积占预计值百分比(FEV1%pred)、总IgE(tIgE)、屋尘螨(Der p)特异性IgE(sIgE)、粉尘螨(Der f)sIgE、其他吸入性过敏原种类数是SCIT不良反应发生的危险因素(均P<0.1)。将其纳入多因素Logistic回归分析,结果显示,年龄、近1年哮喘急性发作次数、tIgE、Der p sIgE、Der f sIgE、其他吸入性过敏原种类数是独立危险因素(P均<0.05),基于此结果绘制诺莫图。绘制受试者操作特征曲线进行模型评价,曲线下面积为0.877(灵敏度73.9%,特异度90.8%),且预测概率与实际发生概率一致性较好,内部验证表明该模型具有较好的预测效能。结论年龄、近1年哮喘急性发作次数、tIgE、Der p sIgE、Der f sIgE、其他吸入性过敏原种类数为儿童螨SCIT不良反应的独立危险因素,基于此绘制的诺莫图具有较好的预测价值。
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.
