舌下免疫治疗季节性变应性鼻炎的Meta分析
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摘要
目的:系统评价舌下免疫治疗季节性变应性鼻炎患者的疗效和不良反应。方法:计算机检索PubMed、Embase、Cochrane Library、Medline、CBM、万方、中国知网等数据库,文献检索时间限定为2008-01-2017-12,检索舌下免疫治疗季节性变应性鼻炎的随机对照试验的文献,进行筛选,并对纳入的文献进行质量评价、数据提取,使用RevMan 5.3软件进行Meta分析。结果:共纳入10篇文献。Meta分析结果显示:舌下免疫治疗较对照组治疗季节性变应性鼻炎可以降低症状评分[SMD=-0.30,95%CI(-0.39～-0.21),P<0.000 01]和药物评分[SMD=-0.18,95%CI(-0.29～-0.08),P=0.000 8];舌下免疫治疗季节性变应性鼻炎在缓解症状方面和减少药物使用方面不受年龄限制;舌下免疫治疗较对照组的不良反应发生率高,但多表现在局部,如口腔瘙痒、耳部瘙痒、咽喉刺激等。结论:舌下免疫治疗可以改善季节性变应性鼻炎患者的临床症状和减少药物使用,不良反应是轻微可控的。
Objective:To systematically evaluate the efficacy and adverse reactions of sublingual immunotherapy for patients with seasonal allergic rhinitis.Method:Literature databases including PubMed,Embase,Cochrane Library,Medline,CBM,Wanfang,CNKI.The time of literature search was limited from January of 2008 to December of 2017.The literature of randomized controlled trials of sublingual immunotherapy for seasonal allergic rhinitis was screened,the quality of the included literature was evaluated,data was extracted,and meta-analysis was performed using RevMan5.3 software.Result:A total of 10 articles were included.The results of meta-analysis showed that for seasonal allergic rhinitis sublingual immunotherapy compared with the control group can reduce symptom scores(SMD=-0.30,95%CI [-0.39,-0.21],P<0.000 01)and medication scores(SMD=-0.18,95%CI[-0.29,-0.08],P=0.000 8);sublingual immunotherapy for seasonal allergic rhinitis is not restricted by age in the relief of symptoms,and there is no age restriction on reduce medication requirements;sublingual immunotherapy had a higher incidence of adverse reactions than the control group,but it was mostly localized,such as oral pruritus,ear pruritus,throat irritation.Conclusion:Sublingual immunotherapy can alleviate the symptoms and reduce medication requirements in patients with seasonal allergic rhinitis.The adverse reactions are slightly controllable.
Objective:To systematically evaluate the efficacy and adverse reactions of sublingual immunotherapy for patients with seasonal allergic rhinitis.Method:Literature databases including PubMed,Embase,Cochrane Library,Medline,CBM,Wanfang,CNKI.The time of literature search was limited from January of 2008 to December of 2017.The literature of randomized controlled trials of sublingual immunotherapy for seasonal allergic rhinitis was screened,the quality of the included literature was evaluated,data was extracted,and meta-analysis was performed using RevMan5.3 software.Result:A total of 10 articles were included.The results of meta-analysis showed that for seasonal allergic rhinitis sublingual immunotherapy compared with the control group can reduce symptom scores(SMD=-0.30,95%CI [-0.39,-0.21],P<0.000 01)and medication scores(SMD=-0.18,95%CI[-0.29,-0.08],P=0.000 8);sublingual immunotherapy for seasonal allergic rhinitis is not restricted by age in the relief of symptoms,and there is no age restriction on reduce medication requirements;sublingual immunotherapy had a higher incidence of adverse reactions than the control group,but it was mostly localized,such as oral pruritus,ear pruritus,throat irritation.Conclusion:Sublingual immunotherapy can alleviate the symptoms and reduce medication requirements in patients with seasonal allergic rhinitis.The adverse reactions are slightly controllable.
引文
[1]邱前辉.变应性鼻炎免疫治疗的现状和未来[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):9-12.
[2]杨钦泰.变应性鼻炎治疗的三部曲“脱离、脱敏、脱症”[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):3-5.
[3] BUFE A,EBERLE P,FRANKE-BECKMANN E,et al.Safety and efficacy in children of an SQ-standardized grass allergen tablet for sublingual immunotherapy[J].J Allergy Clin Immunol,2009,123:167-173.
[4] WAHN U,TABAR A,KUNA P,et al.Efficacy and safety of 5-grass-pollen sublingual immunotherapy tablets in pediatric allergic rhinoconjunctivitis[J].J Allergy Clin Immunol,2009,123:160-166.
[5] SKONER D,GENTILE D,BUSH R,et al.Sublingual immunotherapy in patients with allergic rhinoconjunctivitis caused by ragweed pollen[J].J Allergy Clin Immunol,2010,125:660-666.
[6] BLAISS M,MALONEY J,NOLTE H,et al.Efficacy and safety of timothygrass allergy immunotherapy tablets in North American children and adolescents[J].J Allergy Clin Immunol,2011,127:64-71.
[7] NELSON H S,NOLTE H,CRETICOS P,et al.Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults[J].J Allergy Clin Immunol,2011,127:72-80.
[8] NAYAK A S,ATIEE G J,DIGE E,et al.Safety of ragweed sublingual allergy immunotherapy tablets in adults with allergic rhinoconjunctivitis[J].Allergy Asthma Proc,2012,33:404-410.
[9] CRETICOS P S,MALONEY J,BERNSTEIN D I,et al.Randomized controlled trial of a ragweed allergy immunotherapy tablet in North American and European adults[J].J Allergy Clin Immunol,2013,131:1342-1349.
[10]CRETICOS P S,ESCH R E,COUROUX P,et al.Randomized,double-blind,placebo-controlled trial of standardized ragweed sublingual-liquid immunotherapy for allergic rhinoconjunctivitis[J].J Allergy Clin Immunol,2014,133:751-758.
[11]PFAAR O,VAN TWUIJVER E,BOOT J D,et al.A randomized DBPC trial to determine the optimal effective and safe dose of a SLIT-birch pollen extract for the treatment of allergic rhinitis:results of a phase II study[J].Allergy,2016,71:99-107.
[12]SCADDING G W,CALDERON M A,SHAMJI M H,et al.Effect of 2years of treatment with sublingual grass pollen immunotherapy on nasal response to allergen challenge at 3years among patients with moderate to severe seasonal allergic rhinitis:the GRASS randomized clinical trial[J].JAMA,2017,317:615-625.
[13]JUTEL M,AGACHE I,BONINI S,et al.International consensus on allergy immunotherapy[J].J Allergy Clin Immunol,2015,136:556-568.
[14]CANONICA G W,COX L,PAWANKAR R,et al.Sublingual immunotherapy:World Allergy Organization position paper 2013update[J].World Allergy Organ J,2014,7:6-9.
[15]程雷.变应性鼻炎特异性舌下免疫治疗[J].临床耳鼻咽喉头颈外科杂志,2015,29(3):197-199.
[16]邢志敏,王梓敬,李世昌.重视预防治疗在变应性鼻炎治疗体系中的作用[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):6-8.
[2]杨钦泰.变应性鼻炎治疗的三部曲“脱离、脱敏、脱症”[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):3-5.
[3] BUFE A,EBERLE P,FRANKE-BECKMANN E,et al.Safety and efficacy in children of an SQ-standardized grass allergen tablet for sublingual immunotherapy[J].J Allergy Clin Immunol,2009,123:167-173.
[4] WAHN U,TABAR A,KUNA P,et al.Efficacy and safety of 5-grass-pollen sublingual immunotherapy tablets in pediatric allergic rhinoconjunctivitis[J].J Allergy Clin Immunol,2009,123:160-166.
[5] SKONER D,GENTILE D,BUSH R,et al.Sublingual immunotherapy in patients with allergic rhinoconjunctivitis caused by ragweed pollen[J].J Allergy Clin Immunol,2010,125:660-666.
[6] BLAISS M,MALONEY J,NOLTE H,et al.Efficacy and safety of timothygrass allergy immunotherapy tablets in North American children and adolescents[J].J Allergy Clin Immunol,2011,127:64-71.
[7] NELSON H S,NOLTE H,CRETICOS P,et al.Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults[J].J Allergy Clin Immunol,2011,127:72-80.
[8] NAYAK A S,ATIEE G J,DIGE E,et al.Safety of ragweed sublingual allergy immunotherapy tablets in adults with allergic rhinoconjunctivitis[J].Allergy Asthma Proc,2012,33:404-410.
[9] CRETICOS P S,MALONEY J,BERNSTEIN D I,et al.Randomized controlled trial of a ragweed allergy immunotherapy tablet in North American and European adults[J].J Allergy Clin Immunol,2013,131:1342-1349.
[10]CRETICOS P S,ESCH R E,COUROUX P,et al.Randomized,double-blind,placebo-controlled trial of standardized ragweed sublingual-liquid immunotherapy for allergic rhinoconjunctivitis[J].J Allergy Clin Immunol,2014,133:751-758.
[11]PFAAR O,VAN TWUIJVER E,BOOT J D,et al.A randomized DBPC trial to determine the optimal effective and safe dose of a SLIT-birch pollen extract for the treatment of allergic rhinitis:results of a phase II study[J].Allergy,2016,71:99-107.
[12]SCADDING G W,CALDERON M A,SHAMJI M H,et al.Effect of 2years of treatment with sublingual grass pollen immunotherapy on nasal response to allergen challenge at 3years among patients with moderate to severe seasonal allergic rhinitis:the GRASS randomized clinical trial[J].JAMA,2017,317:615-625.
[13]JUTEL M,AGACHE I,BONINI S,et al.International consensus on allergy immunotherapy[J].J Allergy Clin Immunol,2015,136:556-568.
[14]CANONICA G W,COX L,PAWANKAR R,et al.Sublingual immunotherapy:World Allergy Organization position paper 2013update[J].World Allergy Organ J,2014,7:6-9.
[15]程雷.变应性鼻炎特异性舌下免疫治疗[J].临床耳鼻咽喉头颈外科杂志,2015,29(3):197-199.
[16]邢志敏,王梓敬,李世昌.重视预防治疗在变应性鼻炎治疗体系中的作用[J].临床耳鼻咽喉头颈外科杂志,2017,31(1):6-8.