PDF(Pubmed)
Abstract：
To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR).
PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2, 2023. Outcomes included symptom scores (SSs), medication scores (MSs), symptom and medication scores (SMSs), new sensitizations, development of asthma, improvement, and treatment-related adverse events (TRAEs). The quality of the included studies was assessed by the modified Jadad scale and Newcastle-Ottawa scale (NOS). Meta-regression was carried out to explore the source of heterogeneity. Subgroup analysis was further conducted in terms of study design [randomized controlled trials (RCTs), cohort studies], allergen [house dust mites (HDMs), grass pollen], treatment duration (≥ 24, 12-23 or < 12 months), allergen immunotherapy (AIT) modality (drops or tablets), and AIT protocol [continuous, pre-seasonal, co-seasonal, or after the grass pollen season (GPS)]. Sensitivity analysis was conducted for all outcomes. A Bayesian framework and a Monte Carlo Markov Chain (MCMC) model were developed for indirect comparison.
Totally 50 studies with 10813 AR children were included, with 4122 treated with SLIT, 1852 treated with SCIT, and 4839 treated with non-SLIT or non-SCIT therapy. For direct comparison, the SLIT group had a similar SS to the SCIT group [pooled standardized mean difference (SMD): 0.41, 95% confidence interval (CI): -0.46, 1.28, P = 0.353]. Comparable MSs were observed in the SLIT and SCIT groups (pooled SMD: 0.82, 95%CI: -0.88, 2.53, P = 0.344). For indirect comparison, no significant differences were found in SSs (pooled SMD: 1.20, 95% credibility interval (CrI): -1.70, 4.10), MSs (pooled SMD: 0.57, 95%CrI: -1.20, 2.30), SMSs (pooled SMD: 1.80, 95%CrI: -0.005, 3.60), new sensitizations [pooled relative risk (RR): 0.34, 95%CrI: 0.03, 3.58], and development of asthma (pooled RR: 0.68, 95%CrI: 0.01, 26.33) between the SLIT and SCIT groups; the SLIT group illustrated a significantly lower incidence of TRAEs than the SCIT group (pooled RR: 0.17, 95%CrI: 0.11, 0.26).
Considering both efficacy and safety, SLIT might be a more favorable AIT than SCIT in the treatment of pediatric AR, which may serve as a decision-making reference for clinicians.
PROSPERO (CRD42023460693).
PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2, 2023. Outcomes included symptom scores (SSs), medication scores (MSs), symptom and medication scores (SMSs), new sensitizations, development of asthma, improvement, and treatment-related adverse events (TRAEs). The quality of the included studies was assessed by the modified Jadad scale and Newcastle-Ottawa scale (NOS). Meta-regression was carried out to explore the source of heterogeneity. Subgroup analysis was further conducted in terms of study design [randomized controlled trials (RCTs), cohort studies], allergen [house dust mites (HDMs), grass pollen], treatment duration (≥ 24, 12-23 or < 12 months), allergen immunotherapy (AIT) modality (drops or tablets), and AIT protocol [continuous, pre-seasonal, co-seasonal, or after the grass pollen season (GPS)]. Sensitivity analysis was conducted for all outcomes. A Bayesian framework and a Monte Carlo Markov Chain (MCMC) model were developed for indirect comparison.
Totally 50 studies with 10813 AR children were included, with 4122 treated with SLIT, 1852 treated with SCIT, and 4839 treated with non-SLIT or non-SCIT therapy. For direct comparison, the SLIT group had a similar SS to the SCIT group [pooled standardized mean difference (SMD): 0.41, 95% confidence interval (CI): -0.46, 1.28, P = 0.353]. Comparable MSs were observed in the SLIT and SCIT groups (pooled SMD: 0.82, 95%CI: -0.88, 2.53, P = 0.344). For indirect comparison, no significant differences were found in SSs (pooled SMD: 1.20, 95% credibility interval (CrI): -1.70, 4.10), MSs (pooled SMD: 0.57, 95%CrI: -1.20, 2.30), SMSs (pooled SMD: 1.80, 95%CrI: -0.005, 3.60), new sensitizations [pooled relative risk (RR): 0.34, 95%CrI: 0.03, 3.58], and development of asthma (pooled RR: 0.68, 95%CrI: 0.01, 26.33) between the SLIT and SCIT groups; the SLIT group illustrated a significantly lower incidence of TRAEs than the SCIT group (pooled RR: 0.17, 95%CrI: 0.11, 0.26).
Considering both efficacy and safety, SLIT might be a more favorable AIT than SCIT in the treatment of pediatric AR, which may serve as a decision-making reference for clinicians.
PROSPERO (CRD42023460693).
摘要：
■系统地比较皮下免疫治疗（SCIT）和舌下免疫治疗（SLIT）在过敏性鼻炎（AR）儿童中的疗效和安全性。
■PubMed,Embase,科克伦图书馆,和WebofScience从成立到2023年3月2日进行了搜索。结果包括症状评分（SS），药物评分（MS），症状和药物评分（SMS），新的致敏剂，哮喘的发展，改进,和治疗相关不良事件（TRAEs）。通过改良的Jadad量表和Newcastle-Ottawa量表（NOS）评估纳入研究的质量。进行Meta回归以探索异质性的来源。根据研究设计[随机对照试验（RCT），队列研究]，过敏原[屋尘螨(HDMs)，草花粉]，治疗持续时间（≥24、12-23或<12个月），过敏原免疫疗法（AIT）模式（滴剂或片剂），和AIT协议[连续，季节性前，同季,或在草花粉季节（GPS）之后]。对所有结果进行敏感性分析。建立了贝叶斯框架和蒙特卡洛马尔可夫链（MCMC）模型进行间接比较。
■共纳入50项10813名AR儿童的研究，用SLIT处理4122，1852年用SCIT治疗，和4839用非SLIT或非SCIT疗法治疗。为了直接比较，SLIT组的SS与SCIT组相似[合并标准化平均差(SMD):0.41,95%置信区间(CI):-0.46,1.28,P=0.353].在SLIT和SCIT组中观察到相当的MS(合并SMD:0.82,95CI:-0.88,2.53,P=0.344)。为了进行间接比较，在SSs中没有发现显著差异(合并SMD：1.20，95%可信区间(CrI)：-1.70，4.10)，MS（合并SMD：0.57，95%CrI：-1.20，2.30），SMS（合并SMD：1.80，95%CrI：-0.005，3.60），新的致敏剂[合并相对风险（RR）：0.34，95％CrI：0.03，3.58]，SLIT组和SCIT组之间发生哮喘(合并RR:0.68,95%CrI:0.01,26.33);SLIT组的TRAE发生率明显低于SCIT组(合并RR:0.17,95%CrI:0.11,0.26).
■考虑到疗效和安全性，在小儿AR的治疗中，SLIT可能是比SCIT更有利的AIT，可作为临床医生的决策参考。
■PROSPERO（CRD42023460693）。
■PubMed,Embase,科克伦图书馆,和WebofScience从成立到2023年3月2日进行了搜索。结果包括症状评分（SS），药物评分（MS），症状和药物评分（SMS），新的致敏剂，哮喘的发展，改进,和治疗相关不良事件（TRAEs）。通过改良的Jadad量表和Newcastle-Ottawa量表（NOS）评估纳入研究的质量。进行Meta回归以探索异质性的来源。根据研究设计[随机对照试验（RCT），队列研究]，过敏原[屋尘螨(HDMs)，草花粉]，治疗持续时间（≥24、12-23或<12个月），过敏原免疫疗法（AIT）模式（滴剂或片剂），和AIT协议[连续，季节性前，同季,或在草花粉季节（GPS）之后]。对所有结果进行敏感性分析。建立了贝叶斯框架和蒙特卡洛马尔可夫链（MCMC）模型进行间接比较。
■共纳入50项10813名AR儿童的研究，用SLIT处理4122，1852年用SCIT治疗，和4839用非SLIT或非SCIT疗法治疗。为了直接比较，SLIT组的SS与SCIT组相似[合并标准化平均差(SMD):0.41,95%置信区间(CI):-0.46,1.28,P=0.353].在SLIT和SCIT组中观察到相当的MS(合并SMD:0.82,95CI:-0.88,2.53,P=0.344)。为了进行间接比较，在SSs中没有发现显著差异(合并SMD：1.20，95%可信区间(CrI)：-1.70，4.10)，MS（合并SMD：0.57，95%CrI：-1.20，2.30），SMS（合并SMD：1.80，95%CrI：-0.005，3.60），新的致敏剂[合并相对风险（RR）：0.34，95％CrI：0.03，3.58]，SLIT组和SCIT组之间发生哮喘(合并RR:0.68,95%CrI:0.01,26.33);SLIT组的TRAE发生率明显低于SCIT组(合并RR:0.17,95%CrI:0.11,0.26).
■考虑到疗效和安全性，在小儿AR的治疗中，SLIT可能是比SCIT更有利的AIT，可作为临床医生的决策参考。
■PROSPERO（CRD42023460693）。
