Systematic Review On Efficacy And Prognosis Factors In Predicting Clinical Response Of Specific Immunotherapy For Children Asthma

PARTⅠSystematic Review on Efficacy of Sublingual Immunotherapy for Childhood Asthma with Mite AllergenObjective: To assess the efficacy of sublingual immunotherapy for asthma in children who are sensitive to mite and provide evidence for clinical therapy and future trial.Method: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (Clinical Trials), CBM, CNKI were searched till November 30 2008, using the terms (asthma AND specific immunotherapy AND mite AND control trial).According to inclusion and exclusion criteria, articles were evaluated by three reviewers. Randomised controlled trials (RCTs) were assessed according to the Juni assessment .Software RevMan 4.2.10 was used to carry out statistical analysis. Analysis was performed by the method of Standardised Mean Differences (SMD) using a random-effects model. P values < 0.05 were considered statistically significant . Subgroup analyses were performed according to the type of allergen administered and the duration of treatment. The materials which can not be pooled were carried out the descriptive analysis.Results: 11 articles which involved 722 participants identified were eligible randomised controlled trials and included。We observed symptom scores SMD = -1.74(95%CI-2.83~ -0.64)which indicated sublingual immunotherapy for children asthma with mite allergen could reduce asthma symptom scores .In term of treatment duration and the type of allergen administered, we performed subgroup analysis indicated sublingual immunotherapy with mite allergen could reduce asthma symptom scores during 4and6 months whereas increasing duration of treatment beyond 12 months does appear to increase the treatment e?ect and reduce asthma symptom scores in Dermatophagoides pteronyssinus (D.p)group. There was significantly heterogeneity, most likely due to widely differing scoring systems between studies. Medication scores SMD=-1.56(95%CI-2.95~ -0.17)suggest that medication scores was lower in treatment group than in control group. According to treatment duration and the type of allergen administered, we performed subgroup analysis indicated sublingual immunotherapy with mite allergen could reduce medication scores in Dermatophagoides pteronyssinus (D.p.) group but not in mixed allergen of D.p / D.f (Dermatophagoides farinae).We use the FEV1 to weigh the lung function. The results of change were FEV1 SMD=0.07(95%CI-0.72~0.86) and FEV1% SMD=-0.02(95%CI-0.85~0.81). There were not significant change between treatment group and control group. Antibody levels of blood serum, specific IgE in two groups of change tendencies were not significant. But the specific IgG4 change in the treatment group is higher than the control group.Conclusion: Sublingual immunotherapy with mite allergen is helpful for reducing the child allergy asthma symptom and medication scores, restoring normal immunologic process. Increasing duration of treatment does not clearly increase efficacy. Meanwhile it is safe for children. But there are not enough evidence to indicate that the Sublingual Immunotherapy with mite allergen treatment group and the control group are different in the specificity IgE level and the lung function. Further multi-centre and large scale RCTs are still needed to be performed to evaluate the efficacy of Sublingual immunotherapy for asthma in children who are sensitive to mite. Further research is required concentrating on optimising allergen dosage and patient selection. PARTⅡPrognosis factors in predicting clinical response to specific immunotherapy of children with asthmaObjective: By analysis of pretreatment parameters used in diagnosing asthma, serum total IgE (t-IgE) levels, onset age and bronchial hyperresponsiveness and so on, we tried to identify whether these factors can be used to predict clinical response of children with allergic asthma post treated by specific immunotherapy(SIT).Methods: 99 children with asthma during Sep, 2007 to Feb, 2009 who had undergone 2 years of SIT administered by means of the subcutaneous immunotherapy routes were recruited in this study. All cases with or without improvement were analyzed by Logistic regression analysis for 11 related factors of clinical response to SIT. Software SPSS17.0 was used to carry on statistical analysis.Results: The average onset age of these 99 children with asthma was 8.66±0.30 years. The proportion of boys and girls was 74/25. Good response to SIT was found in 72 cases (72%) of 99 total patients. 11factors were calculated and tested for correlation with clinical response to SIT. A significant correlation was found among asthma onset age, bronchial hyperresponsiveness, asthma with rhinitis and the clinical response to SIT. The results of Logistic regression analysis indicated that the odds ratio of asthma onset age (X1) was 3.422 (95% CI = 1.064～7.404, P = 0.001) , and the odds ratio of bronchial hyperresponsiveness (X2) was 1.341 (95% CI = 1.065～1.685, P = 0.012).Conclusion: These results suggested that children with asthma whose onset age is younger than 5 years old, especially younger than 3 years old might not be suitable to carry on SIT. If those children are accompanied by the predominant bronchial hyperresponsiveness, they are not more suitable to take SIT.