呼吸道过敏原免疫治疗的新定位：聚焦精准医学

文献信息

中文摘要

引言： 过敏原免疫治疗（AIT）是唯一能够改变IgE介导的呼吸道过敏疾病进展的治疗方法。历史上，AIT依赖于经验性个体化，基于过敏原选择和临床判断。然而，AIT现在正转向结构化的精准医学框架，通过将干预措施与个体特征和反应特征相匹配，来优化患者选择和治疗策略。然而，在精准AIT能够常规实施之前，必须解决关键的方法学和实施挑战。
涵盖领域： 本综述探讨了AIT向精准医学框架的演变。具体而言，我们讨论了改进AIT使用的新兴策略和相关挑战，包括通过分子诊断、数字健康工具和辅助生物疗法来改善患者特征描述、评估反应轨迹和治疗优化。
专家意见： AIT有潜力成为一种个体化的、改变疾病的干预措施。为实现这一目标，该领域需要超越“一刀切”的经验性方法，转向由多变量预测模型和以患者为中心的结果支持的结构化、反应指导策略。虽然目前在证据、结果测量和监管框架方面的局限性阻碍了其转化为可操作的路径，但国际过敏护理界应努力应对这些挑战，并促进AIT更细致、基于证据的使用。

英文摘要

INTRODUCTION: Allergen immunotherapy (AIT) is the only treatment for IgE-mediated respiratory allergy that can modify disease progression. Historically, AIT has relied on empirical personalization, based on allergen selection and clinical judgment. However, AIT is now transitioning to a structured, precision-medicine framework to optimize patient selection and treatment strategies by aligning interventions with individual characteristics and response profiles. However, key methodological and implementation challenges must be addressed before precision AIT can be routinely operationalized.
AREAS COVERED: This review addresses the evolution of AIT toward a precision medicine framework. Specifically, we discuss emerging strategies and associated challenges to refine the use of AIT, including improved patient characterization, assessment of response trajectories, and treatment optimization through molecular diagnostics, digital health tools, and adjunctive biologic therapies.
EXPERT OPINION: AIT has the potential to be an individualized, disease-modifying intervention. To achieve this, the field needs to move beyond 'one size fits all' empirical approaches, toward structured, response-guided strategies supported by multivariable prediction models and patient-centered outcomes. While the current limitations in evidence, outcome measurement, and regulatory frameworks hamper the implementation into actionable pathways, the international community of allergy care should strive to address these challenges and promote a more nuanced evidence-based use of AIT.