山东大学耳鼻喉眼学报 ›› 2018, Vol. 32 ›› Issue (5): 71-74.doi: 10.6040/j.issn.1673-3770.0.2018.158

• ·论著· • 上一篇    下一篇

皮下免疫治疗注射后出现全身不良反应的伴发因素及处理

王坛,武珂,李连庆,宫丽丽   

  1. 聊城市人民医院眼耳鼻咽喉头颈外科, 山东 聊城 252000
  • 收稿日期:2018-03-26 出版日期:2018-09-20 发布日期:2018-09-20
  • 通讯作者: 宫丽丽. E-mail:gll79wm@aliyun.com

Factors associated with systemic adverse reactions after subcutaneous immunotherapy injections and treatment options

WANG Tan, WU Ke, LI Lianqing, GONG Lili   

  1. Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng Peoples Hospital, Liaocheng 252000, Shandong, China
  • Received:2018-03-26 Online:2018-09-20 Published:2018-09-20

摘要: 目的 分析皮下免疫治疗(SCIT)注射后出现全身不良反应的伴发因素及处理方式,以便更安全实施SCIT治疗。 方法 回顾分析2013年1月至2017年12月在变应性疾病门诊行SCIT后出现全身变应反应的病例记录。 结果 SCIT注射4597次(191例),出现全身不良反应共23次(21例),全身不良反应的发生率为0.5%,其中速发性反应17例,迟发性反应6例。出现于初始治疗阶段6例,维持治疗阶段17例。根据WAO免疫治疗指导文件进行分级,1级7例,2级15例,3级1例,4级0例,5级0例。排除伴发因素后继续原剂量注射,无不良反应发生。 结论 全身反应多在剂量维持期出现,饮酒、感染、食入或吸入大量变应原、热水浴、运动、疲劳、情绪应激、空腹、妊娠初期、存在其他的特异性IgE疾病等都是诱发患者对已多次注射、耐受良好的SCIT剂量出现全身不良反应的危险因素。每次注射前详细追问患者近期生活史及严格评定注射者是减少全身变应反应的重要环节。排除伴发因素后继续原剂量注射是安全的治疗方法。

关键词: 变应性鼻炎, 影响因素, 皮下免疫治疗, 全身不良反应

Abstract: Objective To analyze the factors associated with and the treatment of systemic adverse reactions after subcutaneous immunotherapy(SCIT)injections. Methods We retrospectively analyzed the records of patients with systemic anaphylaxis who presented to the Allergic Diseases Outpatient Department between January 2013 and December 2017. Results A total of 4597 SCIT injections had been administered to 191 patients, and 23 cases/instances of systemic adverse reactions were reported in 21 patients. The incidence of systemic adverse reactions was 0.5%. An immediate reaction was observed in 17 and a delayed reaction was observed in 6 cases. Systemic adverse reactions occurred during the initial treatment in 6 and during maintenance treatment in 17 cases. Based on the World Allergy Organization immunotherapy guidelines, 7 cases were classified as grade 1, 15 as grade 2, 1 as grade 3, 0 as grade 4, and 0 as grade 5. After exclusion of the associated factors, continuing to inject the original dose showed no adverse reactions. Conclusion Systemic reactions usually occur during the dose maintenance period. Alcohol intake, infections, ingestion or inhalation of a large number of allergens, hot water baths, exercise, fatigue, emotional stress, fasting, early pregnancy, and a few specific immunoglobulin E-mediated diseases are known risk factors for systemic adverse reactions in patients who receive multiple injections and tend to develop tolerance to the dose. Detailed questioning regarding the patients recent life history prior to each injection and careful assessment of the injector are important to reduce systemic allergic reactions. Continuing to inject the original dose after excluding the contributory factors is safe.

Key words: Allergic rhinitis, Subcutaneous immunotherapy, Systemic adverse reactions, Factors

中图分类号: 

  • R765.4
[1] Knisely AJ, Lee S. Advances in subcutaneous immunotherapy[J]. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(3):216-220.
[2] 邱前辉,卢川,陈建军,等. 变应性鼻炎冲击免疫治疗的安全性研究[J]. 临床耳鼻咽喉头颈外科杂志,2014,28(11):776-779, 784. QIU Qianhui, LU Chuan, CHEN Jianjun, et al. Safety of rush allergen-specific immunotherapy in allergic rhinitis patients[J]. J Clin Otorhinolaryngol Head Neck Surg, 2014, 28(11):776-779, 784.
[3] 李琳,关桂梅,朱冬冬,等. 变应性鼻炎标准化螨变应原皮下免疫治疗患者的疗效及安全性[J]. 中华耳鼻咽喉头颈外科杂志,2012,47(6):445-448. LI Lin, GUAN Guimei, ZHU Dongdong, et al. Efficacy and safety analysis with standardized mite allergen subcutaneous immunotherapy in 90 patients with allergic rhinitis[J]. Chin J Otorhinolaryngol Head Neck Surg, 2012, 47(6):445-448.
[4] 程雷. 变应性鼻炎的特异性免疫治疗[J]. 山东大学耳鼻喉眼学报,2011,25(5):33-35.
[5] Lockey RF, Benedict LM, Turkeltaub PC, et al. Fatalities from inununotherapy(IT)and skin testing(ST)[J]. J Allergy Clin Immunol, 1987, 79(4):660-677.
[6] Reid MJ, Lockey RF, Turkelmub PC, et al. Survey of fatalities from skin testing and immunotherapy 1985-1989[J]. J Allergy Clin Immunol, 1993, 92(1):6-15.
[7] Bemstein DI, Wanner M, Bofish L, et al. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001[J]. J Allergy Clin lmmunol, 2004, 113(6):1129-1136.
[8] Epstein TG, Liss GM, Murphy-Berendts K, et al. AAAAI/ACAAI surveillance study of subcutaneous immunotherapy, years 2008-2012: an update on fatal and nonfatal systemic allergic reactions[J]. J Allergy and Clinl Immunol Pract, 2014, 2(2):161-167.
[9] Bernstein DI, Epstein T, Murphy-Berendts K, et al. Surveillance of systemic reactions to subcutaneous immunotherapy injections: year 1 outcomes of the ACAAI and AAAAI collaborative study[J]. Ann Allergy Asthma Immunol, 2010, 104(6):530-535.
[10] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 变应性鼻炎诊断和治疗指南(2015年,天津)[J]. 中华耳鼻咽喉头颈外科杂志,2016,51(1):6-24. Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of allergic rhinitis[J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(1): 6-24.
[11] Alvarez CE, Bousquet J, Canonica GW, et al. Standards for practical allergen-specific immunotherapy[J]. Allergy, 2006, 61(S82):1-20.
[12] Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy:a practice parameter third update[J]. J Allergy Clin Immunol, 2001, 127(S1):1-55.
[13] Niggemann B, Jacobsen L, Dreborg S, et al. Five-year followup on the PAT study:specific immunotherapy and long-term prevention of asthma in children[J]. Allergy, 2006, 61(7):855-859.
[14] Pajno GB, Barberio G, De Luca F, et al. Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study[J]. Clin Exp Allergy, 2001, 31(9):1392-1397.
[15] Alvarez CE, Bousquet J, Canonica GW, et al. Standards for practical allergen-specific immunotherapy[J]. Allergy, 2006, 61(S82):1-20.
[16] Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter third update[J]. J Allergy Clin Immunol, 2011, 127(S1):1-55.
[17] Zuberbier T, Bachert C, Bousquet PJ, et al. GA2 LEN/EAACI pocket guide for allergen-specific immunotherapy for allergic rhinitis and asthma[J]. Allergy, 2010, 65(12):1525-1530.
[18] Cox L, Larenas-Linnemann D, Lockey RF, et al. Speaking the same language: the world allergy organization subcutaneous immunotherapy systemic reaction grading system[J]. Allergy Clin Immunol, 2010, 125(3):569-574.
[19] 李孟荣,王晓宁,姜晗丹,等. 变应哮喘鼻炎患者尘螨变应原皮下免疫治疗后不良反应234例分析及处理[J]. 中国儿科杂志,2012,50(10):726-731. LI Mengrong, WANG Xiaoning, JIANG Handan, et al. Analysis of adverse reactions induced by subcutaneous immunotherapy against dust mite allergy in 234 cases with allergic rhinitis and asthma[J]. Chin J Pediatr, 2012, 50(10):726-731.
[20] 祝凤霞,张融,徐金梅,等. 儿童屋尘螨变应原皮下特异性免疫疗法的不良反应分析[J].实用临床医药杂志,2013,17(22):196-197.
[21] 中国变应性鼻炎研究协作组. 变应性鼻炎皮下免疫治疗专家共识2015[J]. 中国耳鼻咽喉头颈外科,2015,22(8):379-404.
[22] Alvare-Cuesta E, Bousquet J, Canorica GW, et al. Standards for practical allergen-specific immunotherapy[J]. Allergy, 2006, 61(S82):1-20.
[1] 廖礼兵,刘绮明,宗凌,翟锦明,张建国. 42例耳鸣伴听觉过敏患者特征分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 31-36.
[2] 卢汉桂,林歆胜,姚丹勉,魏永新,李创伟. 变应性鼻炎大鼠IL-35的表达及对辅助性T细胞免疫调节的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 66-70.
[3] 侯小兵,任同力,张毅博. 69例梅尼埃病伴耳鸣的发病特点及影响因素[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 37-40.
[4] 浦洪波,杜晓东. 无锡地区2 000例变应性鼻炎变应原检测结果分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 105-107.
[5] 陈鸣,俞雪飞. 浅谈伴有变应性鼻炎的慢性鼻窦炎的治疗[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 18-22.
[6] 吴湘萍. 患者管理方式对变应性鼻炎舌下含服粉尘螨滴剂疗效的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 68-72.
[7] 李松,王宗贵,杨景朴,张竹萍. 鼻内镜下翼管神经切断术进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 72-76.
[8] 郅莉莉,宋道亮. 嗜酸性粒细胞及IL5在上颌窦后鼻孔息肉与鼻息肉中表达的差异[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 43-46.
[9] 张晓莉,于泓,韩冬梅,杨瑞民,戚伟. 泪道激光联合引流管植入治疗泪道阻塞的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 84-86.
[10] 万文锦,王文,程雷. 尘螨变应性鼻炎皮下免疫治疗与舌下免疫治疗的荟萃分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 103-108.
[11] 刘怀涛,马瑞霞,程雷. 难治性变应性鼻炎的外科治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 18-21.
[12] 关凯,李丽莎. 鼻腔冲洗在变应性鼻炎防治中的应用[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 22-27.
[13] 朱新华. 变应性鼻炎冲击免疫治疗的临床应用[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 13-17.
[14] 史丽,赵莉,张红萍. 变应性鼻炎的长期抗炎治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 9-12.
[15] 刘静. 基于整体观念变应性鼻炎的中医辨证论治[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 28-30.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!