局部鼻腔免疫疗法(LNIT),一种替代的非注射免疫疗法,理论上是直接在受影响的器官中诱导免疫耐受的有效方法。LNIT比注射免疫疗法更方便,侵入性更小,系统反应较少。克服LNIT局限性的佐剂的开发提高了其作为替代过敏原免疫疗法的可能性。
评价LNIT对变应性鼻炎患者的临床和免疫学疗效及安全性。
使用OVIDMedline和Embase对比较LNIT和安慰剂的随机对照试验进行了系统搜索。结果是鼻部症状总评分(TNSS),症状-药物评分(SMS),药物评分,免疫学评估,和鼻挑衅阈值。数据汇总用于荟萃分析。
共纳入20项研究,共698名参与者。LNIT组在TNSS治疗后有更大的改善,SMS,和药物评分高于对照组(TNSS:标准化平均差[SMD],-1.37[95%置信区间[CI],-2.04至-0.69];SMS:SMD,-1.55[95%CI,-2.83至-0.28];药物评分:SMD,-1.09[95%CI,-1.35至-0.83])。免疫学评估显示血清特异性IgE没有显着差异(平均差[MD],6.35;95%CI,-4.62至17.31),鼻IgE(MD,-0.59;95%CI,-1.99至0.81),或鼻腔嗜酸性粒细胞阳离子蛋白(MD,7.63;95%CI,-18.65至33.91)。仅血清IgG随LNIT显着增加(MD,0.45;95%CI,0.20,0.70)。后处理,LNIT的鼻激发阈值较高(MD,27.30;95%CI,10.13-44.46)。未报告显著不良事件。
LNIT是一种安全的替代变应原免疫治疗途径,无明显不良事件。它改善了临床症状,减少药物使用,并增加鼻激发阈值。
Local nasal immunotherapy (LNIT), an alternative noninjection immunotherapy method, is theoretically an efficient method for inducing immunotolerance directly in the affected organ. LNIT is more convenient and less invasive than injection immunotherapy, with fewer systemic reactions. The development of adjuvants to overcome LNIT\'s limitations raises the possibility of it being an alternative allergen immunotherapy.
To evaluate the clinical and immunological efficacy and safety of LNIT for patients with allergic rhinitis.
A systematic search for randomized controlled trials comparing LNIT and placebo was performed using OVID Medline and Embase. Outcomes were total nasal symptom score (TNSS), symptom-medication score (SMS), medication score, immunological assessment, and nasal provocation threshold. Data were pooled for meta-analysis.
A total of 20 studies with 698 participants were included. The LNIT group had greater posttreatment improvement in TNSS, SMS, and medication score than control (TNSS: standardized mean difference [SMD], -1.37 [95% confidence interval [CI], -2.04 to -0.69]; SMS: SMD, -1.55 [95% CI, -2.83 to -0.28]; and medication score: SMD, -1.09 [95% CI, -1.35 to -0.83]). Immunological assessments showed no significant differences in serum-specific IgE (mean difference [MD], 6.35; 95% CI, -4.62 to 17.31), nasal IgE (MD, -0.59; 95% CI, -1.99 to 0.81), or nasal eosinophil cationic protein (MD, 7.63; 95% CI, -18.65 to 33.91). Only serum IgG significantly increased with LNIT (MD, 0.45; 95% CI, 0.20, 0.70). Posttreatment, nasal provocation threshold was higher with LNIT (MD, 27.30; 95% CI, 10.13-44.46). No significant adverse events were reported.
LNIT is a safe alternative allergen immunotherapy route without significant adverse events. It improves clinical symptoms, reduces medication usage, and increases the nasal provocation threshold.