背景:牛奶过敏(CMA)是婴儿中最常见的过敏,会降低患者及其家人的生活质量。CMA的标准治疗是严格避免牛奶;已经为CMA患者寻求新的治疗策略,例如口服免疫疗法(OIT)。我们旨在评估OIT治疗儿童免疫球蛋白E介导的CMA(IMCMA)的临床疗效和安全性。
方法:我们从5个国际电子数据库中检索了所有使用OIT治疗IMCMA患儿的随机对照试验。如果统计异质性较低,我们使用Mantel-Haenzel固定效应模型估计了每个结果的合并风险比(RR)。
结果:选择了11项研究进行荟萃分析,包括总共469名儿童(242名OIT,227个控件)。OIT中有176名患者(72.7%)脱敏,而对照组中有49名患者(21.6%)脱敏(RR:7.35,95%置信区间(CI):2.82-19.13,p<.0001)。OIT的脱敏效应在3岁以上儿童中尤为显著(RR:18.05,95%CI:6.48-50.26,p<.00001)。虽然副作用很常见,它们通常有轻微的反应,但OIT组使用肾上腺素更为常见(RR:7.69,95%CI:2.16-27.33,p<.002)。
结论:OIT可导致大多数IMCMA患者脱敏,尤其是3岁以上的患者。OIT的一个主要问题是不良事件的频率,虽然大多数是温和的。OIT可能是未来的替代疗法。
BACKGROUND: Cow\'s milk allergy (CMA) is the most common allergy in infants that decreases the quality of life of patients and their families. Standard treatment for CMA is the strict avoidance of milk; new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA. We aimed to assess the clinical efficacy and safety of OIT in the treatment of children with immunoglobulin E-mediated CMA (IMCMA).
METHODS: We searched all randomized controlled trials in which OIT is used to treat children with IMCMA from five international electronic databases. We estimated a pooled risk ratio (RR) for each outcome using a Mantel-Haenzel fixed-effects model if statistical heterogeneity was low.
RESULTS: Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OITs, 227 controls). One hundred and seventy-six patients (72.7%) in the OIT were desensitized compared with 49 patients (21.6%) in the control group (RR: 7.35, 95% confidence interval (CI): 2.82-19.13, p < .0001). The desensitization effect of OIT was particularly significant in children over 3 years old (RR: 18.05, 95% CI: 6.48-50.26, p < .00001). Although adverse effects were common, they usually involved mild reactions, but epinephrine use was more common in the OIT group (RR: 7.69, 95% CI: 2.16-27.33, p < .002).
CONCLUSIONS: OIT can lead to desensitization in the majority of individuals with IMCMA, especially in patients over 3 years old. A major problem of OIT is the frequency of adverse events, although most are mild. OIT may be an alternative treatment in the future.