过敏原免疫治疗用于过敏性哮喘的临床评价

文献信息

中文摘要

过敏原免疫治疗（AIT）是IgE介导的过敏性疾病唯一可用的疾病修饰治疗。与传统药物治疗不同，AIT针对驱动过敏性哮喘（AA）的潜在免疫失调，具有诱导停药后持续获益的潜力。本叙述性综述审视了随机对照试验（RCT）和真实世界证据中的现有证据，以提供关于AIT在不同年龄组AA中临床作用的更新且平衡的概述。RCT表明，AIT可改善哮喘症状评分、减少药物需求和急性发作风险，并具有额外的减少激素用量作用；然而，各试验结果并不一致。最强证据仅限于屋尘螨舌下含服片剂，而最新的Cochrane综述认为证据不足以得出确切结论。纳入多达445,000例患者的观察性数据库研究与这些发现一致，报告哮喘事件、药物使用和治疗升级减少，尽管其设计无法进行因果推断。除症状控制外，AIT已显示出预防作用，可中断过敏进程，降低过敏性鼻炎患者新发哮喘的风险，并减缓向更严重哮喘表型的进展。长期随访研究（大多规模较小且为开放设计）提示，AIT停药后获益可能持续长达15年。初步的非对照证据还提示，AIT在部分控制良好的重度哮喘患者中可能可行。总之，AIT在AA管理中代表一种定位独特的疾病修饰策略，其潜在获益涵盖症状控制、预防疾病发生和进展，以及治疗停止后持续存在的长期获益。

英文摘要

Allergen immunotherapy (AIT) is the only available disease-modifying treatment for IgE-mediated allergic disease. Unlike conventional pharmacotherapy, AIT targets the underlying immune dysregulation driving allergic asthma (AA), with the potential to induce sustained off-treatment benefits. This narrative review examines the available evidence from both randomized controlled trials (RCTs) and real-world evidence to provide an updated and balanced overview of the clinical role of AIT in AA across different age groups. RCTs indicate that AIT can improve asthma symptom scores, reduce medication requirements and exacerbation risk, with additional steroid-sparing effects; however, findings are not consistent across trials. The strongest evidence is confined to house dust mite SLIT tablets, and the most recent Cochrane review judged the evidence insufficient for firm conclusions. Observational database studies enrolling up to 445,000 patients are consistent with these findings, reporting reductions in asthma events, medication use and treatment step-up, although their design precludes causal inference. Beyond symptomatic control, AIT has demonstrated a preventive role by interrupting the allergic trajectory, reducing the risk of new-onset asthma in patients with allergic rhinitis, and slowing progression to more severe asthma phenotypes. Long-term follow-up studies, mostly small and open in design, suggest that benefit may persist for up to 15 years after AIT discontinuation. Preliminary uncontrolled evidence also suggests that AIT may be feasible in selected patients with well-controlled severe asthma. In conclusion, AIT represents a uniquely positioned, disease-modifying strategy in the management of AA, with potential benefits spanning symptom control, prevention of disease onset and progression, and long-term benefits persisting after treatment discontinuation.