舌下含服尘螨滴剂治疗单一或多重过敏原儿童变应性鼻炎的疗效观察

王洁; 常换换; 魏苗; 陈福权; 邱建华

doi:10.13201/j.issn.1001-1781.2018.21.010

舌下含服尘螨滴剂治疗单一或多重过敏原儿童变应性鼻炎的疗效观察

- 1. 西安市儿童医院耳鼻咽喉头颈外科(西安, 710003);
- 2. 空军医科大学附属西京医院耳鼻咽喉头颈外科
基金项目:
国家自然科学基金面上项目 (No:81670925)

详细信息

通讯作者: 邱建华, E-mail:qiujh@fmmu.edu.cn

中图分类号: R765.21

收稿日期: 2018-07-31

Effect of sublingual dust mite drops on single or multiple allergens allergic rhinitis in children

- 1 Department of Otorhinolaryngology Head and Neck Surgery, Xi'an Children's Hospital, Xi'an, 710003, China;
- 2 Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Medical University

More Information

Corresponding author: QIU Jianhua, E-mail: qiujh@fmmu.edu.cn

Received Date: 31 July 2018

摘要

摘要: 目的: 评估标准化尘螨滴剂舌下特异性免疫治疗(SLIT)对儿童变应性鼻炎的疗效。方法: 回顾性分析174例接受标准化粉尘螨滴剂进行SLIT 2年的患儿。按变应原种类分为单一尘螨过敏组(61例)和尘螨合并其他过敏组(113例)。通过比较治疗前后的症状评分、药物评分和炎症因子检测,进行疗效分析。结果: ①治疗前和治疗2年后患儿的症状评分:单一尘螨过敏组为(11.27±1.46)分和(3.48±1.50)分;尘螨合并其他过敏组为(11.54±1.50)分和(3.59±1.56)分;组内比较差异有统计学意义(P<0.01)。2组间症状评分,单一尘螨过敏组为(7.68±3.23)分,尘螨合并其他过敏组为(8.14±2.56)分,组间症状评分无明显差异(P>0.05)。②2组患儿治疗前后药物评分:单一尘螨过敏组为(1.67±0.43)分和(0.52±0.40)分,尘螨合并其他过敏组为(1.64±0.44)分和(0.55±0.41)分,组内比较差异有统计学意义(P<0.01);2组间药物评分单一尘螨过敏组为(1.16±0.61)分,尘螨合并其他过敏组为(1.28±0.55)分,组间症状评分差异无统计学意义(P>0.05)。③治疗后血清特异性IgG4均有增高(P<0.01)。④免疫治疗后降低了IL4、IL17α的高表达;升高了IL2、TGF-β1的低表达(P<0.05)。结论: 尘螨SLIT可以明显改善单一尘螨过敏和尘螨合并其他过敏患儿的鼻部症状,减少对症药物的使用,且2组疗效相当。尘螨SLIT不仅可以用于治疗单一尘螨过敏的患儿,也可以用于治疗尘螨合并其他过敏的患儿。尘螨血清特异性IgG4升高可以作为免疫治疗有效的预测指标。免疫治疗后可以恢复Thl/Th2/Th17和Treg平衡。
- 鼻炎 /
- 变应性 /
- 舌下特异性免疫治疗 /
- 儿童
Abstract: Objective: Evaluation of the efficacy of standardized dust mite drops in sublingual immunotherapy(SLIT) for allergic rhinitis in children.Method: A retrospective analysis of 174 children who received SLIT with standardized dermatophagoides farinae drops for 2 years. These patients had been divided into two groups:monoasensitized group(n=61) and polysensitized group(n=113). The total medication score(TMS), total nasal symptoms score(TNSS) and inflammatory factors were evaluated before and after SLIT treatment.Result: ①After SLIT treatment for 2.0 year, the TNSS in the monosensitized group is(11.27±1.46) and(3.48±1.50), polyasensitized group is (11.54±1.50) and (3.59±1.56), there are significant difference of TNSS between two groups(P<0.01). But the improvements of the TNSS between the two groups have no significant difference(P>0.05), the monosensitized group is(7.68±3.23); polysensitized group is (8.14±2.56). ②Two groups of children with TMS before and after treatment were obviously improved, monosensitized group is (1.67±0.43) and (0.52±0.40), polysensitized group is(1.64±0.44) and (0.55±0.41). There are significant difference of TMS between two groups(P<0.01). But the improvements of the TMS between the two groups have no obvious difference(P>0.05), the monsensitized group is(1.16±0.61); polysensitized group is(1.28±0.55).③Specific IgG4 serum is increased after treatment(P<0.01). ④After immunotherapy, the expression of IL4 and IL-17α is down-regulated, IL-2 and TGF-β1 is up-regulated.Conclusion: ①Dust mites under the SLIT, can significantly improve the monosensitized and polyasensitized allergic children nasal symptoms, reduce the drug use, and two groups have the equivalent effect. ②Dust mite drops SLIT, can be used to the monosensitized and polyasensitized allergic children. ③The rise of dust mites specific IgG4 can be used as immunotherapy effective predictors. ④After immunotherapy, Thl/Th2/Thl7 and Treg can be re-balanced.
- rhinitis /
- allergic /
- sublingual immunotherapy /
- children

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参考文献(31)

[1]	ASHER M I, MONTEFORT S, BJORKSTEN B, et al.ISAAc Phase Three Study Group:Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and ec-zema in childhood:I-SAAc Phases One and Three repeat mul-ticountry cross-sectional surveys[J].Lancet, 2006, 368:733-743.
[2]	ALI A O, MOHAMED E.Sublingual Immunotherapy in Allergic Rhinitis:Efficacy, Safety, Adherence and Guidelines[J].Clin Exp Otorhinolaryngol, 2014, 7:241-243.
[3]	INCORVAIA C, MAURO M, LEO K, et al.Adherence to sublingual immunotherapy[J].Curr Allergy Asthma Rep, 2016, 16:12-14.
[4]	中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉科学分会.变应性鼻炎的诊治原则和推荐方案 (2004年, 兰州)[J].中华耳鼻咽喉头颈外科杂志, 2005, 40 (3):166-167.
[5]	中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组.变应性鼻炎免疫治疗专家共识[J].中华耳鼻咽喉头颈外科杂志, 2011, 46 (12):976-980.
[6]	WANG X D, ZHANG M, LOU H F, et al, An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005to 2011[J].Allergy, 2016, 71:1170-1180.
[7]	BALATSOURAS D G, KOUKOUTSIS G, GANELISP, et al.Study of allergic rhinitis in childhood[J].Int JOtolaryngol, 2011, 2011:487532.
[8]	SPERGEL J M, PALLER A S.A topic dermatitis andt heatopicmarch[J].J allergy Clin Immunol, 2003, 112:S118-127.
[9]	INCORVAIA C.Treating allergic rhinitis by sublingual immunotherapy:a review[J].Ann Super Sanita, 2012, 48:172-176.
[10]	ZUBERBIER T, CANONICAG W, SILVA B D, et al.Specific immunotherapy with allergens:an important tool in the treatment of the allergic diseases[J].JDtsch Dermatol Ges, 2012, 10:879-886.
[11]	PAJNO G B.Clinical practice recommendations for allergen-specific immunotherapy in children:the Italian consensus report[J].Italian J Pediat, 2017, 43:13-17.
[12]	ELENBURG S, BLAISS M S.Current status of sublingual immunotherapy in the United States[J].World Allergy Organ J, 2014, 7:24-27.
[13]	INCORVAIA C, RA D I, CELANI C, et al.Treating allergic rhinitis by sublingual immunotherapy:a review[J].Ann Ist Super Sanita, 2012, 48:172-176.
[14]	KIOTSERIDIS H.Adherence and quality of life in adults and children during 3-years of SLIT treatment with Grazax-a real life study[J].Npj Primary Care Respiry Med, 2018, 28:1-9.
[15]	LEMBERG M L, EBERLE P, SHAHHOSSEINI K.Importance of quality of life for adherence to sublingual immunotherapy[J].Biol Med Res Int, 2016, 2016:1-5.
[16]	THOMAS W R, SMITH W A, HALES B J, et al.Characterization and immunobiology of house dust mite allergens[J].Int Arch Alleryg Immunol, 2002, 129:1-18.
[17]	LEE J E, CHOI Y S, KIM M S, et al, Efficacy of sublingual immunotherapy with house dust mite extract in polyallergen sensitized patients with allergic rhinitis[J].Ann Allergy Asthma Immunol, 2011, 107:79-84.
[18]	尤少华, 秦晓燕, 徐丛, 等.舌下含服和皮下注射特异性免疫治疗变应性鼻炎的疗效研究[J].临床耳鼻咽喉头颈外科杂志, 2016, 30 (9):689-693.
[19]	程雷, 吴海燕, 田慧琴.维生素D在变应性鼻炎发病中的作用[J].临床耳鼻咽喉头颈外科杂志, 2016, 30 (9):675-677.
[20]	KINACIYAN T, JAHNSCHMID B, RADAKOVICS A, et al.Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1homolog Mal d 1[J].JAllergy Clin Immunol, 2007, 119:937-943.
[21]	MAROGNA M, SPADOLINI I, MASSOLO A, et al.Effects of sublingual immunotherapy for multiple or single allergens in polysensitized patients[J].Ann Allergy Asthma Immunol, 2007, 98:274-280.
[22]	王成硕, 张伟, 王向东, 等, 儿童变应性鼻炎免疫治疗的临床疗效及免疫学机制的研究[J].中华耳鼻咽喉头颈外科杂志, 2011, 46 (1):36-39.
[23]	MILNER J D.IL-17producing cells in host defense and atopy[J].Curr Opin Immunol, 2011, 23:784-788.
[24]	GOTOH M, KAMINUM A, NAKAYA A, et al.Identification of biomarker sets for predicting the efficacy of sublingual immunotherapy against pollen-induced allergic rhinitis[J].Int Immunol, 2017, 29:291-300.
[25]	MOINGEON P.Progress in the development of specific immunotherapies for house dust mite allergies[J].Exp Rev Vscc, 2013, 12:1463-1473.
[26]	WAMBRE E, JAMES E A, KWOK W W.Characterization of CD4+ T cell subsets in allergy[J].Curr Opin Immunol, 2012, 24:700-706.
[27]	LLOYD C M, SAGLANI S.T cells in asthma:influences of genetics, environment, and T-cell plasticity[J].J Allergy Clin Immunol, 2013, 131:1267-1270.
[28]	WILKE C M, BISHOP K, FOX D, et al.Deciphering the role of Th17 cells in human disease[J].Trends Immunol, 2011, 32:603-605.
[29]	SOUWER Y, SZEGEDI K, KAPSENBERG M L, et al.IL-17and IL-22in atopic allergic disease[J].Curr Opin Immunol, 2010, 22:821-826.
[30]	STEWART C A, METHENY H, IIDA N, et al.Interferon-dependent IL-10 production by Tregs limits tumor Th17 inflammation[J].J Clin Invest, 2013, 12:4859-4874.
[31]	JABEEN R, KAPLAN M H.The symphony of the ninth:the development and function of Th9 cells[J].Curr Opin Immunol, 2012, 24:303-307.