Preventing progression of allergic rhinitis: the role of specific immunotherapy
Preventing progression of allergic rhinitis: the role of specific immunotherapy
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DOI：
10.1136/adc.2010.183095
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发表时间：
2011-06-01
影响因子：
1
通讯作者：
Fox, Adam T.
中科院分区：
文献类型：
--
作者：
Fiocchi, Alessandro;Fox, Adam T.
过敏性鼻炎和哮喘是过敏性气道疾病的例子。尽管它们的过敏学不同，但这两种疾病都会影响呼吸道的粘膜内层，并通过共同的潜在细胞过程联系在一起，因此，使用“联合气道”方法，它们可以被认为是同一过敏性疾病的一部分。这些疾病通常是共病的，有证据表明儿童过敏性鼻炎是随后发生哮喘的重要危险因素。针对儿童过敏性鼻炎的根本原因的管理策略有可能提供比对症药物更好的症状控制，并防止疾病进展。特异性免疫疗法（SIT）是目前唯一被证明以这种方式靶向疾病的治疗方法。SIT影响过敏性鼻炎的根本原因，产生对过敏原的抗体反应的变化。它已被证明是有效的，在儿童和成人的过敏性鼻炎症状的减少，与治疗完成后持续数年的影响。此外，一些试验提供的证据表明，SIT可以预防儿童和成人过敏性鼻炎患者发生新的过敏和哮喘。一项在儿童/青少年中进行的开放标签、随机对照研究（预防性过敏治疗研究）显示，与对照组相比，接受3年SIT治疗草/桦树花粉诱导的过敏性鼻炎的患者在治疗开始后10年发生哮喘的患者明显较少。一些临床指南承认这种潜在的儿童哮喘预防作用，并需要来自双盲，安慰剂对照试验的额外数据来支持这些发现。
Allergic rhinitis and asthma are examples of allergic airways disease. Despite their differing symptomatology, both disorders affect the mucosal lining of the respiratory tract and are linked by common underlying cellular processes, thus, using the 'united airways' approach, they can be considered part of the same allergic disease. The conditions are often comorbid, and there is evidence to suggest that allergic rhinitis in children is a significant risk factor for subsequent development of asthma. Management strategies that target the underlying cause of allergic rhinitis in children have the potential to offer additional symptom control above that of symptomatic medications, and prevent disease progression. Specific immunotherapy (SIT) is the only currently available treatment that is proven to target the disease in this way. SIT affects the underlying cause of allergic rhinitis, producing changes in antibody responses to allergens. It has been shown to be effective in the reduction of allergic rhinitis symptoms in both children and adults, with effects being sustained for several years after treatment completion. Furthermore, a number of trials provide evidence that SIT may prevent the development of new sensitisations and asthma in children and adults with allergic rhinitis. One such open-label, randomised controlled study in children/adolescents (the Preventive Allergy Treatment Study) showed that significantly fewer patients who received 3 years of SIT for grass/birch pollen-induced allergic rhinitis had developed asthma 10 years after treatment initiation versus controls. Some clinical guidelines acknowledge this potential asthma preventive effect in children and the need for additional data from double-blind, placebo-controlled trials to support these findings.