The effect of allergen immunotherapy in patients with central compartment atopic disease post-surgery.

IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY International Forum of Allergy & Rhinology Pub Date : 2024-09-27 DOI:10.1002/alr.23459
Christian M Meerwein, Peta-Lee Sacks, Jacqueline Ho, Christine Choy, Larry Kalish, Raewyn G Campbell, Ray R Sacks, Richard J Harvey
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Abstract

Objective: To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post-surgery.

Methods: A retrospective cohort of surgically treated, HDM-sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22-item sino-nasal outcome test (SNOT-22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin-exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell × 109/L), tissue eosinophilia (% > 100/HPF), and serum IgE (kU/L) were also recorded.

Results: Eighty-six CCAD patients were assessed (41 ± 14 yrs, 64% female). AIT was applied in 37% (n = 32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p = 0.02) in the AIT group. At 12 months post-surgery, the AIT group has less MT edema (% ≥ diffuse 15.6 vs. 52.9, p < 0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (% ≥ 4/week, 37.5 vs. 79.6%, p < 0.01). The rhinologic symptoms were similar (21.1 ± 17.1 vs. 20.1 ± 21.6, p = 0.83).

Conclusions: Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de-escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation.

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过敏原免疫疗法对手术后中央区特应性疾病患者的影响。
摘要评估过敏原免疫疗法(AIT)对手术后中央隔室特应性疾病(CCAD)和家尘螨(HDM)致敏患者的影响:对表型为 CCAD 的接受过手术治疗、对 HDM 过敏的 CRSwNP 患者进行了回顾性队列评估。根据患者是否将 AIT 作为手术治疗的一部分,将患者分为两组。所有 AIT 患者均在手术前开始接受免疫疗法。主要终点是手术后 12 个月中鼻甲水肿的恢复情况。次要终点是皮质类固醇冲洗使用量(9/L)、组织嗜酸性粒细胞增多(% > 100/HPF),同时还记录了血清 IgE(kU/L):共评估了 86 名 CCAD 患者(41 ± 14 岁,64% 为女性)。37%的患者(32 人)使用了 AIT。基线特征相似,但 AIT 组的结膜症状更严重(72 对 45%,P = 0.02)。术后 12 个月时,AIT 组的 MT 水肿较少(≥弥漫性的百分比为 15.6 vs. 52.9,p 结论:手术和药物治疗可有效缓解眼结膜水肿:手术和药物治疗对控制 CCAD 很有效,但 AIT 的加入改善了过敏现象,并允许局部治疗降级。要进一步证明免疫调节作用,还需要进行更长期的研究。
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来源期刊
CiteScore
11.70
自引率
10.90%
发文量
185
审稿时长
6-12 weeks
期刊介绍: International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.
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