Subilingvalna imunoterapija za alergijski rinitis
Abstract
Background
This is an update of a Cochrane Review first published in The Cochrane Library in Issue 2, 2003.
Allergic rhinitis is a common condition which can significantly impair quality of life. Immunotherapy by injection can significantly reduce symptoms and medication use but its use is limited by the possibility of severe systemic adverse reactions. Immunotherapy by the sublingual route is therefore of considerable interest.
Objectives
To evaluate the efficacy and safety of sublingual immunotherapy for allergic rhinitis in adults and children.
Search methods
We searched the Cochrane ENT Group Trials Register; CENTRAL (2010, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 14 August 2009.
Selection criteria
Randomised, double‐blind, placebo‐controlled trials of sublingual immunotherapy in adults or children. Primary outcome measures were symptom and medication scores. We also collected adverse event data.
Data collection and analysis
Two independent authors selected studies and assessed risk of bias. One author extracted data which was rechecked by two other authors. We used the standardised mean difference (SMD) with a random‐effects model to combine data.
Main results
We included a total of 60 randomised controlled trials in the review. Forty‐nine were suitable for pooling in meta‐analyses (2333 SLIT, 2256 placebo participants). Overall, we found a significant reduction in symptoms (SMD ‐0.49; 95% confidence interval (CI) ‐0.64 to ‐0.34, P < 0.00001) and medication requirements (SMD ‐0.32; 95% CI ‐0.43 to ‐0.21, P < 0.00001) in participants receiving sublingual immunotherapy compared to placebo. None of the trials included in this review reported severe systemic reactions or anaphylaxis, and none of the systemic reactions reported required the use of adrenaline.
Authors' conclusions
This updated review reinforces the conclusion of the original 2003 Cochrane Review that sublingual immunotherapy is effective for allergic rhinitis and has been proven to be a safe route of administration.
PICOs
Laički sažetak
Podjezična imunoterapija za liječenje alergijskog rinitisa (uključujući peludnu groznicu)
Alergijski rinitis je alergijska upala nosne sluznice koja je obilježena crvenilom i svrbežom očiju, začepljenjim nosem i curenjem iz nosa te kihanjem. Najčešći uzrok alergijskog rinitisa su različite vrste peludi (trave i stabla), kućne grinje, plijesan i životinjska prhut.Alergijski rinitis može se javljati povremeno (kao što je peludna groznica) ili trajati cijelu godinu. Liječenje alergijskog rinitisa ovisi o težini i trajanju bolesti, i obično se temelji na uporabi antihistaminika i primjeni kortikosteroida u nos. Ako ti lijekovi ne pomažu u kontroli simptoma, preporučuje se imunoterapija. Imunoterapija uključuje primjenu postupno sve većih doza alergena tijekom duljeg vremenskog razdoblja kako bi se smanjila preosjetljivost pacijenta. To je jedina poznata terapija koja mijenja imunološki odgovor i koja liječi uzrok, a ne simptome.
U ovom Cochrane sustavnom pregledu literature analizirano je 60 kliničkih pokusa koji su pokazali da primjena imunoterapije pod jezik (sublingvalno) može dovesti do značajnog ublažavanja simptoma i potrebe za drugim lijekovima u usporedbi s placebom. Nisu bile zabilježene ozbiljne nuspojave i niti jedan pacijent nije zahtijevao primjenu adrenalina. Ovaj obnovljeni Cochrane sustavni pregled stoga donosi još jače zaključke u odnosu na raniju verziju, koji potvrđuju djelotvornost i sigurnost sublignvalne imunoterapije.
