维生素D状态与补充作为呼吸道过敏中过敏原免疫治疗结局的潜在调节因素：一项结构化叙述性综述。

文献信息

中文摘要

过敏原免疫治疗（AIT）是管理IgE介导的过敏性疾病（如过敏性鼻炎和哮喘）的基石。通过随时间给予受控剂量的过敏原，AIT旨在重新调整免疫耐受，从而改变过敏反应。然而，AIT的临床反应仍具有异质性，一部分患者仅获得部分获益。这种异质性凸显了需要新的辅助方法来增强AIT的免疫调节作用。在此背景下，维生素D因其在免疫稳态和调节中已确立的作用，以及在调节过敏性疾病中新出现的相关性而受到相当关注。本结构化叙述性综述旨在评估AIT期间补充维生素D对临床结局的潜在作用，以及内源性维生素D水平对AIT临床疗效的意义。共回顾了18项研究，其中13项评估AIT期间补充维生素D的影响，5项评估内源性维生素D水平对AIT结局的影响。大多数补充研究报道了支持在AIT基础上添加维生素D的临床结局，但三项研究发现无额外获益，两项研究分别报道仅在较早时间点或在维生素D缺乏患者中获益。在五项检查内源性状态的研究中，三项报道较高的25-羟基维生素D（25(OH)D）水平与更好的AIT结局相关。作为次要结局报道的其他发现包括有利的免疫学变化，如IL-10产生、过敏原特异性IgE水平降低和调节性Treg细胞活性增强，但未正式评估其对临床获益的贡献。然而，由于研究设计、补充方案和结局指标的异质性，各研究结果仍不一致。虽然现有证据提示充足的维生素D状态或补充可能与更好的AIT临床反应相关，但当前发现仍受限于研究设计、补充方案、结局指标的异质性以及通常较小的样本量。因此，这些证据应被视为提示性而非结论性。尽管从一般临床角度纠正维生素D缺乏是适当的，但其作为改善AIT结局的辅助手段的具体用途尚不能常规推荐。需要进一步有足够把握度、标准化、安慰剂对照的研究来阐明其作用并为临床建议提供依据。

英文摘要

Allergen immunotherapy (AIT) represents a cornerstone in managing IgE-mediated allergic diseases, such as allergic rhinitis and asthma. By administering controlled doses of allergens over time, AIT aims to readjust immune tolerance, thereby modifying allergic responses. However, clinical responses to AIT remain heterogeneous, with a subset of patients achieving only partial benefit. This heterogeneity underlines the need for novel adjunctive approaches to potentiate the immunomodulatory effects of AIT. In this context, vitamin D has gained considerable interest, given its well-established role in immune homeostasis and regulation, as well as its emerging relevance in modulating allergic disease. This structured narrative review aims to assess the potential role of vitamin D supplementation during AIT on clinical outcomes as well as the significance of endogenous vitamin D levels on AIT clinical efficacy. A total of 18 studies were reviewed, 13 evaluating the impact of vitamin D supplementation during AIT and 5 assessing the influence of endogenous vitamin D levels on AIT outcomes. Most supplementation studies reported clinical outcomes favoring the addition of vitamin D to AIT, but three found no additional benefit, and two reported a benefit only at an earlier time point, respectively in vitamin D-deficient patients. Of the five studies examining endogenous status, three reported that higher 25-hydroxyvitamin D (25(OH)D) levels were associated with better AIT outcomes. Other findings that were reported as secondary outcomes included favorable immunologic changes, such as IL-10 production, decreased allergen-specific IgE levels, and enhanced regulatory Treg-cell activity, without formal assessment of their contribution to clinical benefit. Nevertheless, findings remain inconsistent across studies due to heterogeneity in study design, supplementation regimens, and outcome measures. While the available evidence suggests that adequate vitamin D status or supplementation may be associated with better clinical responses to AIT, the current findings remain limited by heterogeneity in study design, supplementation regimens, outcome measures, and generally small sample sizes. Therefore, the evidence should be considered suggestive rather than conclusive. Although correction of vitamin D deficiency is appropriate on general clinical grounds, its specific use as an adjunct to improve AIT outcomes cannot yet be routinely recommended. Further adequately powered, standardized, placebo-controlled studies are needed to clarify its role and inform clinical recommendations.