Sublingual immunotherapy (SLIT) represents a safer, more comfortable and more convenient allergen immunotherapy than its subcutaneous counterpart. There is an increasing body of evidence showing that SLIT for house dust mites (HDM), grass, ragweed and/or tree pollen improves allergic symptoms and asthma control.1 It is unclear whether SLIT consistently reduces the occurrence of asthma attacks.1–3 Published in 2016, the MITRA trial was arguably the most robust randomised controlled trial assessing the effect of SLIT (specifically HDM-SLIT) on the prevention of asthma attacks in mild-to-moderate allergic asthma.2 Briefly, the MITRA trial was conducted in 834 people with uncontrolled mild-to-moderate allergic asthma and positive HDM allergen-specific immunoglobulin E (IgE) (≥0.7 kU/L or >3 mm on skin prick—usual cutoffs). After randomisation to HDM-SLIT or placebo, participants were monitored on stable background inhaled corticosteroid (ICS) therapy for 7–12 months, thereafter, reducing their ICS dosing up to complete withdrawal within the next 6 months. This ALK-Abelló-sponsored investigation showed a statistically—and just about clinically significant4—decrease in the risk of moderate-to-severe exacerbation in the intervention arms, no matter the dose of HDM-SLIT. In the original MITRA publication,2 only a few prespecified subgroup ‘responder’ analyses were reported on the trial population (age, sex, allergen sensitisation type and cosensitisation). Unfortunately, no ‘SLIT-responder group’ was identified. The absence of theragnostic markers left clinicians to randomly select who they propose SLIT to, and guidelines to softly suggest HDM-SLIT to be considered as an alternative add-on for uncontrolled mild-to-moderate allergic asthma.3 In this issue of Thorax, Hoof et al from a group of researchers from the pharmaceutical company and academic centres take a …

中文翻译：

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血液嗜酸性粒细胞在预测舌下免疫疗法 (SLIT) 反应中占据中心位置：一个熟悉的转折

舌下免疫疗法（SLIT）比皮下疗法更安全、更舒适、更方便。越来越多的证据表明，针对屋尘螨 (HDM)、草、豚草和/或树木花粉的 SLIT 可改善过敏症状并控制哮喘。1 目前尚不清楚 SLIT 是否能持续降低哮喘发作的发生率。1-3 MITRA 试验于 2016 年发表，可以说是评估 SLIT（特别是 HDM-SLIT）对预防轻度至中度过敏性哮喘哮喘发作效果的最稳健的随机对照试验。2 简而言之，MITRA 试验于 2016 年进行。 834 名未受控制的轻度至中度过敏性哮喘患者和 HDM 过敏原特异性免疫球蛋白 E (IgE) 呈阳性（≥0.7 kU/L 或皮肤刺痛处 >3 毫米——通常的截止值）。随机分配至 HDM-SLIT 或安慰剂后，参与者接受稳定背景吸入皮质类固醇 (ICS) 治疗 7-12 个月的监测，此后减少 ICS 剂量，直至在接下来的 6 个月内完全戒断。这项由 ALK-Abelló 赞助的调查显示，无论 HDM-SLIT 的剂量如何，干预组中度至重度病情加重的风险均具有统计学意义（且几乎具有临床意义）4 降低。在最初的 MITRA 出版物中2，仅报告了对试验人群的少数预先指定的亚组“反应者”分析（年龄、性别、过敏原致敏类型和共敏）。不幸的是，没有发现“SLIT 反应组”。由于缺乏治疗诊断标志物，临床医生必须随机选择他们建议进行 SLIT 的对象，而指南则温和地建议考虑将 HDM-SLIT 作为不受控制的轻至中度过敏性哮喘的替代附加疗法。 3 在本期 Thorax 中，来自制药公司和学术中心的一组研究人员的 Hoof 等人采取了……