作者: Herman Tam , Moises A Calderon , Logan Manikam , Helen Nankervis , Ignacio García Núñez
DOI: 10.1002/14651858.CD008774.PUB2
关键词:
摘要: Background Specific allergen immunotherapy (SIT) is a treatment that may improve disease severity in people with atopic eczema (AE) by inducing immune tolerance to the relevant allergen. A high quality systematic review has not previously assessed efficacy and safety of this treatment. Objectives To assess effects specific (SIT), including subcutaneous, sublingual, intradermal, oral routes, compared placebo or standard eczema. Search methods We searched following databases up July 2015: Cochrane Skin Group Specialised Register, CENTRAL Library (Issue 7, 2015), MEDLINE (from 1946), EMBASE 1974), LILACS 1982), Web Science™ 2005), Global Resource EczemA Trials (GREAT database), five trials databases. We abstracts from recent European North American allergy meetings checked references included studies articles for further trials. Selection criteria Randomised controlled (RCTs) used standardised extracts AE. Data collection analysis Two authors independently undertook study selection, data extraction (including adverse effects), assessment risk bias, analyses. methodological procedures expected Cochrane. Main results We identified 12 RCTs inclusion review; total number participants was 733. The interventions SIT children adults allergic either house dust mite (10 trials), grass pollen, other inhalant allergens (two trials). They were administered subcutaneously (six sublingually (four orally, intradermally Overall, bias moderate, loss follow lack blinding as main concern. Our primary outcomes 'Participant- parent-reported global at end treatment'; symptoms eczema, subjective measures'; 'Adverse events, such acute episodes asthma anaphylaxis'. SCORing Atopic Dermatitis (SCORAD) means measuring effect dermatitis area (A); intensity (B); measures (C), itch sleeplessness, which we used. For treatment', one trial (20 participants) found improvement 7/9 (78%) treated 3/11 (27%) (risk ratio (RR) 2.85, 95% confidence interval (CI) 1.02 7.96; P = 0.04). Another (24 no difference: improved 8/13 (62%) 9/11 (81%) (RR 0.75, CI 0.45 1.26; 0.38). did perform meta-analysis because heterogeneity between these two studies. evidence low. For measures', (184 find SCORAD part C (mean difference (MD) -0.74, -1.98 0.50) sleep disturbance (MD -0.49, -1.03 0.06) more than placebo. For severity, -0.24, -1.00 0.52). One non-blinded (60 reduced -4.20, -3.69 -4.71) participants' overall (P < 0.01), but could pool three due heterogeneity. very low. Seven reported systemic reactions: 18/282 (6.4%) had reaction 15/210 (7.1%) 0.78, 0.41 1.49; moderate). same seven local 90/280 (32.1%) 44/204 (21.6%) group 1.27, 0.89 1.81). As limitations, deemed also be moderate. Of our secondary outcomes, there significant 'Investigator- physician-rated treatment' trials, 262 participants; RR 1.48, 1.16 1.88). None outcome 'Parent- participant-rated using published scale', (n 184), have been mentioned above, C, measures'. Our findings generally inconclusive small unable determine subgroup analyses particular type age level where successful. whether sublingual associated reactions subcutaneous immunotherapy. Authors' conclusions Overall, low. low mainly differing results studies, some relatively few reporting participant-centred measures. limited an effective AE. treatments increased reactions. Future should use formulations proven track record conditions include participant-reported