我们如何改进过敏原免疫疗法作为哮喘和严重哮喘治疗选择的使用?

IF 2.9 3区 医学 Q2 RESPIRATORY SYSTEM Expert Review of Respiratory Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-29 DOI:10.1080/17476348.2023.2251403
Désirée Larenas-Linnemann, Blanca María Morfin Maciel
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引用次数: 0

摘要

引言:对于过敏性哮喘患者,尤其是儿科年龄组的患者,过敏原免疫疗法(AIT)可能是有益的,并且具有长期改变疾病的潜力。涵盖的领域:我们回顾了AIT对过敏性哮喘有益的证据。正确选择可能的AIT候选人至关重要。我们定义了全面的过敏性哮喘诊断:确认哮喘、确认过敏性致敏和在接触相关过敏原时出现症状。我们分析了为什么AIT治疗哮喘的最初试验是矛盾的;我们考虑了系统综述的结果,并讨论了荟萃分析中经常发现的高度异质性。我们评估了最近在舌下AIT中进行的双盲安慰剂对照试验,这些试验为减少急性哮喘恶化和减少吸入皮质类固醇的使用提供了有力的证据。此外,我们展示了真实世界的试验和基于大型药房数据的分析如何证实SLIT和SCIT的这些发现。最后,我们探讨了AIT在严重哮喘患者中的选择,一旦生物治疗得到很好的控制。专家意见:哮喘指南中明确的AIT适应症将有利于过敏性哮喘患者。AIT是适当选择的哮喘患者的一种治疗选择。三年的治疗具有长期耐受的潜力,在停药数年后仍有益处。
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How can we improve our use of allergen immunotherapy as a treatment option for asthma and severe asthma?

Introduction: In patients suffering from allergic asthma, especially in the pediatric age-group, allergen immunotherapy (AIT) could be of benefit and has the potential of long-term disease modification.

Areas covered: We reviewed the evidence for a beneficial effect of AIT in allergic asthma. A correct selection of the possible candidates for AIT is crucial. We define the comprehensive allergic asthma diagnosis: confirming asthma, confirming allergic sensitization and having symptoms on exposure to the relevant allergens.We analyze why the first trials on AIT for asthma were contradictory; we consider the results of systematic reviews and discuss the high degree of heterogeneity often found in meta-analysis. We assess recent, double-blind, placebo-controlled trials in sublingual AIT that provide robust evidence for a reduction in acute asthma exacerbations and a decrease in the use of inhaled corticosteroids. Further, we demonstrate how real-world trials and large pharmacy data-based analyses confirm these findings for SLIT and SCIT. Finally, we explore the option of AIT in severe asthma patients, once well-controlled on biologic therapy.

Expert opinion: Clear indications for AIT in asthma guidelines would benefit allergic asthmatics. AIT is a therapeutic option in appropriately selected asthmatics. Three years treatment has the potential for long-term tolerance, with persisting benefits years after discontinuation.

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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
90
期刊介绍: Coverage will include the following key areas: - Prospects for new and emerging therapeutics - Epidemiology of disease - Preventive strategies - All aspects of COPD, from patient self-management to systemic effects of the disease and comorbidities - Improved diagnostic methods, including imaging techniques, biomarkers and physiological tests. - Advances in the treatment of respiratory infections and drug resistance issues - Occupational and environmental factors - Progress in smoking intervention and cessation methods - Disease and treatment issues for defined populations, such as children and the elderly - Respiratory intensive and critical care - Updates on the status and advances of specific disease areas, including asthma, HIV/AIDS-related disease, cystic fibrosis, COPD and sleep-disordered breathing morbidity
期刊最新文献
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