静脉应用小剂量红霉素防治早产儿喂养不耐受的Meta分析

目的对静脉应用小剂量红霉素防治早产儿喂养不耐受的疗效和安全性的相关文献进行Meta分析,为早产儿喂养不耐受的治疗提供参考依据。方法检索Cochrane图书馆、PubMed、EMBASE、在研试验数据库、中国生物医学文献数据库、中国期刊全文数据库、万方数据库和维普中文科技期刊数据库等。检索红霉素防治早产儿喂养不耐受的RCT文献。按Cochrane系统评价方法进行文献质量评价,采用RevMan5．0．17软件进行Meta分析。结果共纳入18篇RCT文献,文献质量评价A级1篇,B级3篇,C级14篇。共纳入1200例早产儿。Meta分析结果显示：①达到全肠内喂养时间：红霉素预防组加权均数差值（WMD）=-4．18（95％CI：-6．29～-2．08）,红霉素治疗组WMD=-4．69（95％CI：-6．38～-3．00）,两组均可较早实现全肠内喂养;胎龄≤32周亚组WMD=-5．15（95％CI：-12．60—2．30）,与对照组差异无统计学意义。剔除低质量文献行敏感度分析,WMD=～5．48（95％CI：-11．66～0．69）,红霉素治疗组与对照组差异无统计学意义。②红霉素预防组住院时间（WMD=-1．10,95％CI：-3．65～1．37）和NEC发生率（OR=1．01,95％CI：0．24～4．22）与对照组差异无统计学意义;红霉素治疗组13均体重增加（WMD=4．29,95％CI：-2．06～10．64）和NEC发生率（OR=0．68,95％CI：0．18—2．56）与对照组差异无统计学意义;红霉素治疗组恢复至出生体重时间（WMD=-2．45,95％CI：-2．87～-2．04）、症状消失时间（WMD=-1．22,95％CI：-1．33--1．11）及住院时间（WMD=-9．70,95％CI：-11．92～-7．49）与对照组差异有统计学意义。结论对于喂养不耐受高危儿及胎龄≤32周的喂养不耐受早产儿,静脉应用小剂量红霉素的证据尚不足;对于胎龄〉32周的喂养不耐受早产儿,今后研究应确定是否存在一个最佳剂量以缩短静脉营养时间及住院时间,在改善喂养不耐受的症状中红霉素可能起一定的作用。     

去铁酮和去铁胺治疗珠蛋白生成障碍性贫血临床疗效及安全性的Meta分析

目的采用Meta分析对去铁酮＋去铁胺联合治疗重型珠蛋白生成障碍性贫血的临床疗效及安全性进行综合定量评价。方法制定原始文献的纳入标准、排除标准以及检索策略,检索Cochrane图书馆、PubMed、EMBASE、Ovid、Springer、中国生物医学文献光盘数据库、中国期刊全文数据库和维普期刊数据库,检索时间为1985年1月1日至2008年5月31日,获得去铁酮＋去铁胺联合治疗重型珠蛋白生成障碍性贫血的相关文献。采用Cochrane中心推荐的方法对文献质量进行评价。选取血清铁蛋白（SF）、肝组织铁浓度（LIC）、心肌铁含量和不良反应发生率作为主要测量指标,总铁排泄量和心功能作为次要测量指标。采用Review Manager4．3．2软件对满足纳入标准的RCT文献进行Meta分析。计量资料采用加权均数差（WMD）或标准化均数差（SMD）及其95％CI表示,计数资料采用RR及其95％CI表示。结果共检索到相关文献216篇,符合纳入标准的5篇RCT文献（n=229）进入Meta分析,其中4篇文献质量评价为B级,1篇为C级。去铁酮＋去铁胺联合治疗组（联合治疗组）与单用去铁胺治疗组（去铁胺组）比较：治疗12个月后sF下降程度：SMD=-0．04,95％CI：-0．48～0．41;LIC下降程度：SMD=-0．1,95％CI：-0．47—0．27;总铁排泄量：WMD=0．18,95％CI：0—0．37,两组差异均无统计学意义。左心室射血分数改善情况：WMD=3．40,95％CI：0．97～5．82,提示左心室射血分数联合治疗组高于去铁胺组。安全性分析：胃肠道不良反应发生率联合治疗组高于去铁胺组,RR=2．77,95％CI：1．41—5．42。联合治疗组关节不良反应发生率：RR=1．45,95％CI：0．59～3．52;中性粒细胞减少症发生率：RR=0．85,95％CI：0．27～2．68;注射部位不良反应发生率：RR=0．57,95％CI：0．20～1．65,与去铁胺组差异均无统计学意义。1篇文献采用MRIT2^＊测定心肌铁含量,结果显示联合治疗组心肌铁含量下降程度高于去铁胺组。结论联合治疗组的短期疗效及安全性与去铁胺组相当,去除心肌铁含量和改善心功能方面效果优于去铁胺组;联合治疗组最常见的不良反应为胃肠道反应。因纳入文献较少,临床应用本研究结果应谨慎,进一步结论仍有待大样本、多中心和高质量的RCT研究来验证。     

长链多不饱和脂肪酸与足月儿智能和精神运动发育关系的Meta分析

目的对添加长链多不饱和脂肪酸（LCPUFAs）配方奶喂养足月儿的智能和精神运动发育进行评价。方法使用相关的检索词检索Cochrane图书馆、PubMed、EMBASE、中国生物文献数据库和中文科技期刊全文数据库,获取添加LCPUFAs配方奶喂养的相关RCT文献,由2名评价者进行资料提取和文献质量评价,对同质资料运用RevMan4．3．2软件进行Meta分析。结果共6项研究（n=894）符合纳入标准进入Meta分析。根据随机方法、分配隐藏、盲法和随访情况评分,文献质量A级5篇,B级1篇。按年龄分为12月龄和18月龄亚组。Meta分析结果显示：①对智力发育指数的影响：12月龄亚组加权均数差值（WMD）：-1．66（95％CI：-4．09～0．76,P=0．18）,18月龄亚组WMD=-0．70（95％CI：-2．90～1．51,P=0．54）,两亚组合并分析,合并WMD=-1．13（95％CI：-2．76～0．50,P=0．17）;②对精神运动发育指数的影响：12月龄亚组WMD=-1．14（95％CI：-4．39～2．12,P=0．49）,18月龄亚组WMD=0．70（95％CI：-0．88～2．27,P=0．39）,两亚组合并分析：合并WMD=0．35（95％CI：-1．07～1．77,P=0．63）。提示添加LCPUFAs配方奶喂养足月儿的智力发育指数和精神运动发育指数与未添加LCPUFAs配方奶组的差异均无统计学意义。结论现有的证据显示,添加LCPUFAs的配方奶对足月儿智能及精神运动发育无积极或消极影响。     

MRS研究大脑γ-氨基丁酸水平与抑郁症关系的Meta分析

目的 采用meta的分析方法综合评价MRS相对定量指标GABA与抑郁症的关系.方法 搜索Pubmed、EMBASE、Cochrane图书馆、CNKI等数据库相关中英文文献.检索日期至2016年11月.对纳入文献进行质量评价,并提取相关文献中抑郁症组与健康对照组的相对定量指标GABA值,用review manager 5.3统计软件进行Meta分析.结果 共纳入文献9篇(中文1篇、英文8篇).Meta分析结果显示抑郁症组的GABA值低于健康对照组,SMD为-0.57(95％ CI:-1.00,-0.14),差别有统计学意义.不同脑区分析显示抑郁症组枕叶皮层与前扣带皮层GABA值低于健康对照组,SMD分别为-0.74(95％ CI:-1.43,-0.06)、-1.10(95％ CI:-1.64,-0.56)差别有统计学意义;抑郁症缓解组与健康对照组GABA值SMD为0.01(95％ CI:-0.29,0.32),差别无统计学意义.结论 MRS测量脑内GABA值在评价抑郁症中有一定的临床价值,但由于存在较大的异质性,未来仍需要更多更高质量的研究进一步分析.     

细菌内毒素对粉尘螨诱导的哮喘小鼠肺部炎症的免疫调节

目的了解不同时间给予细菌内毒素对过敏性哮喘小鼠炎症反应的免疫调节作用。方法将60只小鼠随机分成4组，分别为模型组（Der f）、对照组（生理盐水）、实验A组（致敏前LPS＋Der f）、实验B组（致敏后LPS＋Der f），观察肺组织病理学变化并进行支气管肺泡灌洗液（BALF）细胞计数与分类，ELISA法检测小鼠BALF与脾细胞培养液中IL-4、IL-5、IFN-γ、IL-12及血清中特异性IgE、IgG2a水平。结果与模型组比较，实验A组的BALF中炎细胞总数、嗜酸性粒细胞（EOS）、IL-4、IL-5显著降低，而IL-12显著升高（P均〈0．05），血清中特异性IgE（sIgE）显著降低，而特异性IgG2a（sIgG2a）显著升高（P均〈0．05）；与哮喘组比较，实验B组仅BALF中IL-4水平显著升高（P〈0．05）。结论致敏前LPS能显著抑制过敏性哮喘的炎细胞浸润并下调TH2型免疫反应，而致敏后LPS未显示此功能，提示LPS致敏前给予对过敏性哮喘的发生有保护作用。     

丙戊酸对癫痫患儿骨代谢影响的Meta分析

目的采用Meta分析方法定量分析丙戊酸对癫痫患儿骨代谢的影响。方法电子检索中国维普科技期刊数据库、万方数据库、中国知网、中国生物医学文献数据库、EMCC、PubMed、OVID及Cochrance图书馆,纳入丙戊酸对癫痫患儿骨代谢影响的观察性研究,采用NOS量表评估纳入文献的质量。采用RevMan5．2软件进行Meta分析。结果14篇文献（英文10篇,中文4篇）进入Meta分析,均为病例对照研究,累计病例组507例,对照组480例。Meta分析结果显示,丙戊酸对血钙（MD=0．0l,95％CI：-0．05—0．06,P=0．13）、血磷（MD=-0．03,95％CI：-0．19—0．13,P=0．67）、碱性磷酸酶（MD=0．37,95％CI：-19．02～19．77,P=0．97）无明显影响,但丙戊酸组骨密度低于对照组,MD=-0．03,95％CI：-0．06～-0．00,P=0．03;丙戊酸组甲状旁腺激素水平显著高于对照组,MD=4．83,95％CI：1．15～8．50,P=0．01;丙戊酸组25-羟维生素D水平显著低于对照组,MD=-2．46,95％CI：-4．37～-0．55,P=0．01。结论现有证据表明,丙戊酸对癫痢患儿血钙、血磷和ALP无显著影响．但对骨密度、25-OH—VtiD和PTH有影响。     

广州地区不同年龄组支气管哮喘儿童变应原体外检测结果分析

目的观察广州地区不同年龄组支气管哮喘（哮喘）儿童总IgE（TIgE）水平和15种变应原特异性IgE（slgE）的阳性分布情况。方法入选859例小儿呼吸门诊的0～14岁哮喘儿童，采用德国FookeAllergy-O-LIQ变应原检测系统，通过酶联免疫捕获法检测TI姬和变应原sIgE，比较0～2岁、3～5岁、6～10岁和11～14岁组哮喘儿童的TIgE水平和15种变应原slgE的阳性分布差异。结果TIgE在6～10岁组[148．2（260．8）IU／ml]和11～14岁组[156．5（329．4）IU／ml]分别明显高于0～2岁组[38．7（82．2）IU／ml]和3～5岁组[64．2（138．2）IU／ml]（均为P〈0．01）。吸入变应原sIgE阳性率前4位是屋尘（51．9％）、屋尘螨（49．7％）、粉尘螨（47．7％）和热带螨（9．3％），其阳性率均随年龄的增加而t增高，4个年龄组比较差异具有统计学意义（r分别为61．987、125．439、152．507和87．997，均P〈0．01）。食物变应原sIgE阳性率前4位是牛奶（37．7％）、全蛋（23．1％）、花生（6．3％）和小麦粉（5．6％），4个年龄组比较差异具有统计学意义（r分别为50．766、22．913、8．275和7．808，均P〈0．05），牛奶和全蛋的阳性率因年龄的增加而降低，而花生和小麦的阳性率分别在6～10岁组和3～5岁组达高峰后下降。结论广州地区哮喘儿童TIgE水平和主要的吸入变应原屋尘、屋尘螨、粉尘螨及热带螨sIgE阳性率总的变化趋势随年龄的增加而增高，而主要的食物变应原牛奶和鸡蛋的sIgE阳性率则随年龄的增加而下降。     

去乳糖奶粉降低重度脱水急性腹泻幼儿治疗失败率——基于14项随机对照试验的Meta分析

目的通过Meta分析评价去乳糖奶粉治疗3岁以下儿童急性腹泻的疗效。方法制定原始文献纳入和排除标准,检索PubMed、EMBASE、Cochrane图书馆、中国知网和万方数据库,并回溯纳入文献的参考文献,获得去乳糖奶粉治疗幼儿急性腹泻的RCT文献。对文献进行质量评价。以治疗失败率、腹泻病程为主要结局指标,以体重增加量为次要结局指标。采用RevMan5．2软件进行Meta分析。计数资料采用RR及其95％CI表示,计量资料以均数差（MD）及其95％cI表示。结果共检索到339篇文献,14篇RCT文献进入Meta分析。3篇文献未报道具体的随机分配方法,5篇文献结果数据不具完整性,2篇文献存在选择性报告结果,1篇文献有高度的其他偏倚来源。漏斗图检验未见显著发表偏倚。Meta分析结果显示,治疗失败率去乳糖奶粉组显著低于含乳糖奶粉组,RR=0．46,95％CI：0．35～0．60,P〈0．00001,其中包含重度脱水患儿亚组的RR=0．38,95％CI：0．27～0．54。腹泻病程去乳糖奶粉组显著低于含乳糖奶粉组,MD=一0．95d,95％CI：一1．15～一0．74d,P〈0．00001。去乳糖奶粉组治疗急性腹泻体重增加不明显。结论在纠正水和电解质失衡的基础上,去乳糖奶粉可降低幼儿急性腹泻治疗失败率,缩短腹泻病程,特别是重度脱水的急性腹泻幼儿的治疗失败率。如果有更新、更多的高质量临床试验可进一步补充证据。     

阿奇霉素对比阿莫西林/克拉维酸治疗儿童急性中耳炎疗效和安全性的Meta分析

目的采用Meta分析方法比较阿奇霉素与阿莫西林／克拉维酸治疗儿童急性中耳炎疗效和安全性。方法电子检索中国生物医学文献数据库、中文科技期刊数据库、中国知网、万方数据库、中国医学会数字化期刊、PubMed、Cochrane Library和EMBASE数据库,检索起止时间均从建库至2013年8月。纳入阿奇霉素对比阿莫西林／克拉维酸治疗儿童急性中耳炎的RCT文献,对文献进行质量评价。评估临床治愈率、治疗失败率和不良反应。采用RevMan5．0软件进行数据分析,二分类变量采用OR及其95％CI表示。结果共纳入13篇RCT文献（5081例患儿）。Meta分析结果显示,阿奇霉素组与阿莫西St,／克拉维酸组在〈10d临床治愈率（OR=0．69,95％CI：0．46～1．02）、-19d临床治愈率（OR=0．88,95％CI：0．68～1．13）、～29d临床治愈率（OR=0．99,95％CI：0．83—1．19）、t〉30d临床治愈率（OR=1．00,95％CI：0．72～1．39）和治疗失败率（OR=0．87,95％CI：0．65～1．17）差异均无统计学意义。阿奇霉素组恶心（OR=0．44,95％CI：0．20～0．97）、皮疹（OR=0．48,95％CI：0．31～0．75）、腹泻（OR=0．38,95％CI：0．25～0．57）和稀便（OR=0．41,95％CI：0．20—0．81）的发生率显著低于阿莫西林／克拉维酸组。结论阿奇霉素与阿莫西林／克拉维酸治疗儿童中耳炎疗效相当且不良反应少。     

Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis

Allergic rhinitis is a common condition which, at its most severe, can significantly impair quality of life despite optimal treatment with antihistamines and topical nasal corticosteroids. Allergen injection immunotherapy significantly reduces symptoms and medication requirements in allergic rhinitis but its use is limited by the possibility of severe systemic reactions. There has therefore been considerable interest in alternative routes for delivery of allergen immunotherapy, particularly the sublingual route. The objective was to evaluate the efficacy of sublingual immunotherapy (SLIT), compared with placebo, for reductions in symptoms and medication requirements. The Cochrane Controlled Clinical Trials Register, MEDLINE (1966-2002), EMBASE (1974-2002) and Scisearch were searched, up to September 2002, using the terms (Rhin* OR hay fever) AND (immunotherap* OR desensiti*ation) AND (sublingual). All studies identified by the searches were assessed by the reviewers to identify Randomized Controlled Trials involving participants with symptoms of allergic rhinitis and proven allergen sensitivity, treated with SLIT or corresponding placebo. Data from identified studies was abstracted onto a standard extraction sheet and subsequently entered into RevMan 4.1. Analysis was performed by the method of standardized mean differences (SMD) using a random effects model. P-values < 0.05 were considered statistically significant. Subgroup analyses were performed according to the type of allergen administered, the age of participants and the duration of treatment. Twenty-two trials involving 979 patients, were included. There were six trials of SLIT for house dust mite allergy, five for grass pollen, five for parietaria, two for olive and one each for, ragweed, cat, tree and cupressus. Five studies enrolled exclusively children. Seventeen studies administered the allergen by sublingual drops subsequently swallowed, three by drops subsequently spat out and two by sublingual tablets. Eight studies involved treatment for less than 6 months, 10 studies for 6-12 months and four studies for greater than 12 months. All included studies were double-blind placebo-controlled trials of parallell group design. Concealment of treatment allocation was considered adequate in all studies and the use of identical placebo preparations was almost universal. There was significant heterogeneity, most likely due to widely differing scoring systems between studies, for most comparisons. Overall there was a significant reduction in both symptoms (SMD -0.42, 95% confidence interval -0.69 to -0.15; P = 0.002) and medication requirements [SMD -0.43 (-0.63, -0.23); P = 0.00003] following immunotherapy. Subgroup analyses failed to identify a disproportionate benefit of treatment according to the allergen administered. There was no significant reduction in symptoms and medication scores in those studies involving only children but total numbers of participants was too small to make this a reliable conclusion. Increasing duration of treatment does not clearly increase efficacy. The total dose of allergen administered may be important but insufficient data was available to analyse this factor.     

舌下含服粉尘螨滴剂治疗儿童哮喘1年疗效的初步观察

目的初步观察舌下含服粉尘螨滴剂治疗儿童变应性哮喘1年的临床疗效。方法收集2009年5月至2010年6月我院哮喘门诊就诊轻中度哮喘患者55例,采用随机、开放、平行对照的的研究方法将其分为:试验组(粉尘螨滴剂+吸入激素)30例,对照组(单纯吸入激素)25例。临床观察1年,比较2组哮喘症状评分、急性发作次数、发作持续天数、吸入激素量、肺功能及呼气峰流量变异率的改变情况。结果从治疗的第36周开始2组患儿的日均哮喘症状评分出现差异,差异持续至1年观察结束。试验组1年哮喘的急性发作次数、发作持续天数明显少于对照组;从治疗的40周开始2组患儿ICS用量出现差异,差异持续至1年观察结束。治疗1年后试验组肺功能FEF50、MMEF占预计值百分比明显高于对照组(P<0.05),而2组FEV1、PEF、FEF75比较未见明显差异(P均>0.05)。试验组PEFR变异率于治疗29～56周小于对照组(P<0.05)。结论舌下含服粉尘螨滴剂可改善哮喘患儿症状,减少哮喘急性发作次数、持续天数及严重程度,减少ICS剂量、改善患儿小气道肺功能、降低PEFR变异率。     

Comparison of the efficacy of subcutaneous and sublingual immunotherapy in mite-sensitive patients with rhinitis and asthma--a placebo controlled study.

BACKGROUND: The efficacy of therapy with sublingual allergen extracts is unproven. OBJECTIVE: To evaluate the clinical and immunologic outcome of sublingual immunotherapy and to compare the results with subcutaneous immunotherapy and placebo in 36 patients with rhinitis and asthma due to mite allergy. METHOD: Thirty-six patients with rhinitis and asthma due to mite allergy were randomly divided into three groups in order to receive subcutaneous injections with allergenic extracts, sublingual drops with solutions of purified standardized allergen preparations, or sublingual placebo for a period of 1 year. Assessment of clinical and immunologic efficacy included symptom and medication scores, methacholine provocation tests, skin prick tests, and specific IgE and IgG4 antibody concentrations. RESULTS: Subcutaneous immunotherapy for both rhinitis and asthma was clinically effective. Patients treated with sublingual immunotherapy had decreased rhinitis symptoms (P < .01) but no change in asthma scores. Medication scores significantly decreased in both actively treated groups (P < .01) at the first year compared with baseline. When skin prick tests were evaluated, the subcutaneously treated group had a significant decrease in the wheal diameter of D. pteronyssinus (P < .01), D. farinae (P < .05), and histamine (P < .05) while other two groups showed no difference. There was no significant change in methacholine PC20 values in all groups at the end of the first year when compared with baseline. No change in D. pteronyssinus and D. farinae specific IgE levels were observed; however, specific IgG4 concentrations were significantly higher than baseline both in sublingual and subcutaneous immunotherapy groups (P < .05) after 1 year immunotherapy. No significant difference was obtained in any of these parameters in the placebo group. CONCLUSION: Sublingual immunotherapy may be effective in patients with allergic rhinitis. Further, we believe it is a potential therapy for allergic asthmatic patients. The clinical usefulness of this form of immunotherapy (when administered to larger study groups for a longer time) and the mechanisms underlying its immunologic effect deserve additional studies.     

An evaluation of mattress encasings and high efficiency particulate filters on asthma control in the tropics

The effect of two allergen avoidance modalities, Allergy Control Covers (ACC) and High Efficiency Particulate Filters (HEPA) on asthma control in children were evaluated. This was an open study involving 24 dust mite sensitive asthmatic children. Following a 4 week run-in period, the subjects were randomly allocated to use mattresses fitted with ACC (n = 6), HEPA filters in their bedrooms (n = 12) or act as controls (n = 6) for a study duration of 4 months. Measurements of the major Dermatophagoides spp. mite allergens, Der p 1 and Der f 1, levels in dust samples obtained from mattresses were made at baseline, 1, 2 and 4 months post implementation. Daily symptom scores including morning and evening peak flow readings, and monthly spirometry and exercise bronchoprovocation tests were carried out Our results showed that dust mite allergen levels in mattresses fell at 1 and 2 months post implementation in the ACC group (p<0.05). In contrast, no decrease in allergen levels was seen in the HEPA and control group. At the end of the 16 weeks, only the ACC group showed improvement in FEV1 and reduction in diurnal peak expiratory flow rate (p<0.05). Improvement in mean symptom scores was also observed for both the ACC and HEPA groups, but not the control groups (p<0.05). Although the numbers in this study were small, the results Indicate that the effectiveness on mite exposure barrier covers was short-lived, and the improvement in asthma control though documented was not obvious.     

Effect of specific immunotherapy added to pharmacologic treatment and allergen avoidance in asthmatic patients allergic to house dust mite

BACKGROUND: Although several studies support the efficacy of specific immunotherapy in allergic asthma, its benefit compared with that of standardized pharmacologic intervention remains unknown. OBJECTIVE: A double-blind, placebo-controlled trial in 72 patients with mild-to-moderate asthma and allergy to house dust mite (HDM; Dermatophagoides species) was conducted to assess the effects of specific immunotherapy added to guideline-adjusted pharmacologic treatment and allergen avoidance. METHODS: After 1 observational year of pharmacologic treatment and standard measures of HDM avoidance, 2 groups of asthmatic subjects were randomly assigned to receive specific immunotherapy consisting of subcutaneous injections of either a mixture of Dermatophagoides pteronyssinus and Dermatophagoides farinae vaccine (n=41) or placebo (n=31) for 3 years. Medications were adjusted every 3 months according to the Global Initiative for Asthma guidelines. RESULTS: The adjustment of treatment was associated with a reduction in asthma symptom scores in all subjects. The addition of specific immunotherapy was associated with a decrease in the number of subjects requiring rescue bronchodilators, an increase in morning and evening peak expiratory flow, and a reduced skin sensitivity to HDM extracts. The addition of specific immunotherapy had no significant effects on the cumulative dose of inhaled corticosteroids, asthma symptoms, lung volumes, or bronchial responsiveness to methacholine. CONCLUSION: These results suggest that specific immunotherapy added to pharmacologic treatment and HDM avoidance provides marginal but statistically significant clinical benefits, possibly by reducing the allergic response of asthmatic patients sensitized to HDM.     

Efficacy of sublingual immunotherapy in the treatment of allergic rhinitis in pediatric patients 3 to 18 years of age: a meta-analysis of randomized, placebo-controlled, double-blind trials.

OBJECTIVE: To evaluate the efficacy of sublingual immunotherapy (SLIT) in the treatment of allergic rhinitis in children. DATA SOURCES: A comprehensive search of the EMBASE, MEDLINE, LILACS, and CINAHL databases from January 1966 to February 10, 2006, was performed. STUDY SELECTION: Randomized, double-blind, placebo-controlled trials of SLIT in the treatment of allergic rhinitis in patients 18 years or younger were selected. Outcomes measured were symptom scores and rescue medication use. Analysis was performed with standardized mean differences (SMDs) and a random-effects model. RESULTS: Seventy articles were identified and reviewed. Ten studies, published between 1990 and 2004, fulfilled the selection criteria. Five hundred seventy-seven patients were initially included in the studies. Of these patients, 484 (245 SLIT and 239 placebo) had a final clinical evaluation and could be evaluated. A relevant heterogeneity due to widely differing scoring systems was found. Overall, there was a significant reduction in both symptoms (SMD, 0.56, 95% confidence interval, 1.01-0.10; P = .02) and medication use (SMD, 0.76; 95% confidence interval, 1.46-0.06; P = .03) after immunotherapy. The subanalyses performed for treatment duration and type of allergen showed that SLIT for more than 18 months and with pollen extracts was effective compared with SLIT courses shorter than 18 months and with mites. CONCLUSION: The results of this meta-analysis showed that,compared with placebo, SLIT with standardized extracts is effective in pediatric patients with allergic rhinitis.     

The efficacy of sublingual immunotherapy for house dust mites respiratory allergy: results of a GA²LEN meta-analysis

Recent meta-analyses documented the efficacy and safety of sublingual immunotherapy (SLIT) in patients with allergic rhinitis (AR) and asthma (AA). Although SLIT appeared globally effective, the sub-analyses for single allergens provided uncertain results. This study is aimed to investigate the efficacy of SLIT with house dust mite (HDM) extracts in AR and AA through an updated reassessment of randomized controlled trials. Electronic databases were searched up to March 31, 2008, for randomized DBPC trials, assessing the efficacy of SLIT in AR and AA due to HDM sensitization. Outcomes were symptom scores and rescue medications use. For AR, eight studies fulfilled the selection criteria. A significant reduction in symptoms of AR (SMD −0.95; CI 95%−1.77 to −0.14 P  = 0.02) was found in 194 patients (adults and children) receiving SLIT compared to 188 receiving placebo. For AA, with nine studies, similar results were found for symptoms (SMD −0.95; CI 95%−1.74 to −0.15 P  = 0.02) in 243 patients (adults and children) receiving SLIT compared to 209 receiving placebo. A reduction in rescue medication use was found for AR (SMD −1.88; CI 95%−3.65 to −0.12 P  = 0.04) in 89 patients, and AA (SMD −1.48; CI 95%−2.70 to −0.26 P  = 0.02) in 202 patients. A relevant inter-study heterogeneity was detected. Promising evidence of efficacy for SLIT, using mite extract in allergic patients suffering from AR and AA, are herein shown. These findings suggest that more data are needed, derived from large-population-based high quality studies, and corroborated by objective outcomes, mainly for AA.     

承德地区粉尘螨滴剂治疗过敏性鼻炎疗效观察与分析

目的评价舌下含服粉尘螨滴剂治疗过敏性鼻炎的临床疗效,为临床预防诊治提供依据。方法采用治疗前后对照,比较98例尘螨过敏性鼻炎患者在接受两年舌下含服粉尘螨滴剂治疗前、后的体征及症状评分,评估舌下含服粉尘螨滴剂治疗的疗效,统计不良反应发生率并对患者进行指导。结果治疗两年后,患者症状评分及体征评分较治疗前均明显减少,儿童组症状总分由治疗前10．27±1．87降至4．34±1．57;成人组症状总分由治疗前11．26±1．54降至5．81±1．52,差异有统计学意义（P〈0．05）。儿童组体征得分由治疗前2．78±0．68降至1．54±0．57;成人组体征得分由治疗前2．86±0．59降至1．82±0．41,差异有统计学意义（P〈0．05）。儿童组治疗有效率为94．74％,成人组治疗有效率为88．33％,总有效率为91．54％。5例患者（5．10％）出现局部不良反应,3例（3．06％）出现全身轻微不良反应,未出现全身严重不良反应。结论舌下含服粉尘螨滴剂治疗过敏性鼻炎是一种安全有效的方法,疗效确切、患者痛苦小、不良反应发生率低,值得临床大范围推广和使用。     

Immunotherapy in children with allergic asthma: effect on bronchial hyperreactivity and pharmacotherapy

BACKGROUND: Immunotherapy has been shown to reduce allergen sensitivity to allergens such as cat and dust mite. The aim of this study was to investigate the effect of cat or dust mite immunotherapy on bronchial hyperreactivity and the need for inhaled corticosteroids in children with asthma, cat or dust mite allergy, and hay fever. SUBJECTS: Twenty-nine children, 7 to 16 years old, completed the 3-year study. They were randomly allocated to receive cat/dust mite or placebo and birch/timothy immunotherapy. METHODS: Before immunotherapy was begun and then once each year, bronchial histamine challenges were performed. Bronchial allergen challenge with the perennial allergen was done before and after the 3-year study. Pharmacotherapy was given according to a standardized protocol. RESULTS: PC20 allergen increased significantly in both the active immunotherapy group (P <.001) and in the placebo-pollen group (P <.05). PC20 histamine increased continuously in the active immunotherapy group (P <.05 and P =.002 after 1 and 3 years, respectively) and had also increased after 3 years in the placebo-pollen group (P <.05). The difference between the 2 groups was significant for PC20 allergen (P =.001) but not for PC20 histamine. There was no significant change in the dose of inhaled budesonide needed for symptom control in either of the groups. CONCLUSION: Pollen immunotherapy combined with inhaled corticosteroids results in improvement of both cat/dust mite bronchial sensitivity and hyperresponsiveness to histamine. The combination of cat or dust mite, pollen immunotherapy, and inhaled budesonide enhances this improvement. Cat immunotherapy also induces cat allergen tolerance.     

Allergen-specific conventional immunotherapy decreases immunoglobulin E-mediated basophil histamine releasability

BACKGROUND: Allergen-specific immunotherapy has proven to be clinically effective in the treatment of patients with atopic asthma; however, the mechanisms are still unclear. Several noted immunological changes include an increase of the allergen-specific IgG antibody, a reduction in the allergen-specific IgE antibody subsequent to transient increase, an allergen-specific T cell shift in cytokine production from Th2 to Th1, and a decrease in quantity and activity of basophils and mast cells. OBJECTIVE: To analyse the changes of basophil histamine release in response to IgE-mediated and non-IgE-mediated stimuli before and after conventional house-dust mite immunotherapy in children who suffer from atopic asthma. METHODS: Fourteen Dermatophagoides farinae (Df) sensitive asthmatic children with conventional immunotherapy were examined. Basophil histamine releasability was measured 0 months (just before immunotherapy), 4 months and 9 months after immunotherapy. Basophils were stimulated with Df and goat anti-human IgE antibody as IgE-mediated stimuli; and formyl-Met-Leu-Phe (fMLP) and calcium ionophore A23187 as non-IgE-mediated stimuli. Accordingly, the asthma symptom score was used to assess clinical outcome and the skin test reactivity to Df was measured. RESULTS: In contrast to pre-immunotherapy activity, 4 and 9 months after immunotherapy there were significant decreases in histamine release by Df and by anti-IgE antibody. The histamine release by fMLP and by calcium ionophore showed no significant changes after immunotherapy. Histamine release by Df demonstrated significant correlation to that by anti-IgE antibody and by fMLP, yet there was no observable correlation between histamine release by Df and by calcium ionophore. The asthma symptom score decreased significantly 4 and 9 months after immunotherapy and showed significant correlation with histamine release by Df. The skin test reactivity (allergen/histamine ratio) remained constant 4 months after immunotherapy, but decreased significantly 9 months after immunotherapy. CONCLUSION: Basophils have the potential to play an important role in the early clinical improvement of conventional immunotherapy in children with atopic asthma, which may be a result of the decreased IgE-mediated histamine releasability during immunotherapy.