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[大学生论坛]:SLIT和SCIT对治疗过敏性鼻炎和哮喘的益处

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CCC 发表于 2017-12-30 19:37:48 | 显示全部楼层 |阅读模式
本帖最后由 CCC 于 2017-12-30 19:42 编辑

Allergen immunotherapy (AIT) has been in use since more than one century, when Leonard Noon experimentally proved its efficacy in hayfever. Since then, AIT was administered only as subcutaneous injections (SCIT) until the sublingual route (SLIT) was proposed in 1986.
过敏原免疫疗法(AIT)早在一个世纪多以前就已经开始使用了,Leonard Noon用实验证明了AIT治疗干草热的功效。从那时起,AIT只通过皮下注射(SCIT)进行给药,直到1986年有人提出了舌下注射(SLIT)。

The use of SLIT was proposed following several surveys from the USA and UK that repeatedly reported fatalities due to SCIT. These reports raised serious concerns about the safety and the risk/benefit ratio of AIT. Many cases of life-threatening events with SCIT were due to avoidable human errors in administration, but a relevant fraction of them remained unexplained and unpredictable. Subsequently, in a few years, SLIT gained credibility and was included in the official documents and guidelines as a viable alternative to traditional SCIT.
美国和英国对SCIT的致死事故进行了反复报道,这引起了人们对AIT的安全性和风险比/利益比的严重担忧。在这之后有人提出了使用SLIT。许多因SCIT而有生命危险的例子是由于本可避免的人为给药失误,但是这些错误却无法解释,也不可预知。几年之后,SLIT有了可靠性,作为传统SCIT的可行替代方案被列入官方文件和指南。

Of note, the local bronchial (aerosol) and the intranasal route of administration were attempted after the 1970s as alternatives to SCIT: the bronchial route was soon abandoned due to the poor efficacy and side effects, and the local nasal route, although effective and safe, was judged substantially impractical.
值得注意的是,在20世纪70年代以后,局部支气管(气雾剂)和鼻内给药方法被尝试当SCIT的替代品:由于功效差而且有副作用,支气管给药方法很快就被放弃;局部鼻腔给药方法虽然有效且安全,却被认为是非常不切实际的。

In contrast to SCIT, SLIT was tested in very large clinical trials, including hundreds of patients and with dose-ranging experimental designs, so that some products (tablets) for grass, mite, and ragweed were officially approved as commercial drugs by regulatory agencies such as the Food and Drug Administration and the European Medicines Agency and the optimal content for the maintenance dose was identified for selected allergens. In parallel, the knowledge on the mechanisms of action of AIT was rapidly refined, leading to further improvements, such as the chemically modified extracts and the use of adjuvants to enhance efficacy and safety.
与SCIT相比,SLIT进行了非常大的涉及剂量范围的临床试验测试,有数百名患者参与其中。一些草,螨和豚草的产品(片剂)被食品药品监督管理局和欧洲药品管理局等监管机构正式批准为商业药物,被选定的过敏原的维持剂量的最佳含量也得到了确定。同时,AIT作用机制的知识也得到了迅速优化,得到了进一步的改善。比如化学改性的提取物和使用佐剂来提高功效和安全性。

In addition, in the last 10 years, there has been an increasing scientific and clinical interest in AIT applied to food allergies, in particular in children, with the use of orally administered extracts. The results are so far encouraging, at least for cow's milk, egg, and peanut, although the use of treatment is still restricted to clinical trials or within specialized centers. Finally, the introduction of molecular- or component-resolved diagnosis has allowed detailing the prescription of AIT, by better delineating true sensitization versus cross-reactivity. This latter point is also in strict relation to the use of recombinant, engineered or highly purified molecules, instead of raw extracts, for the desensitization process.
除此之外,在过去的10年里,通过口服的方式来治疗食物过敏的AIT越来越具有科学和临床意义,尤其是对小孩来说。虽然此疗法仍然限于在临床试验或专业中心中使用,至少对于牛奶,鸡蛋和花生这些致敏物质来说,研究结果是令人鼓舞的。最后,分子或成分分析诊断的引入可以更好地描述真实的致敏作用与交叉反应性,这使详细描述AIT成为可能。后一点也与重组设计或高度纯化的分子(而不是原始提取物)用于脱敏过程有严格关系。

Source: Current Allergy and Asthma Reports

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