变应原疫苗免疫治疗对过敏性支气管哮喘合并鼻炎的疗效分析

目的评估标准化变应原疫苗免疫治疗（allergeni mmunotherapy,AIT）对过敏性哮喘合并鼻炎患者的近期疗效。方法设计调查问卷,对我院门诊接受标准化变应原疫苗-安脱达（Alutard（SQ）AIT治疗的39例过敏性哮喘合并鼻炎患者进行问卷调查,应用哮喘控制水平分级和哮喘控制测试（ACT）评分评价哮喘的疾病控制水平,应用鼻炎病情评分（RCT）评价过敏性鼻炎的控制情况。结果 39例患者治疗前后的哮喘控制水平分级（Z=-7.235,P〈0.05）、ACT评分（t=16.533,P〈0.05）、RCT评分（t=16.650,P〈0.05）、情绪（χ2=34.873,P〈0.05）等均有较大程度的改善。结论标准化AIT治疗能明显改善过敏性哮喘合并鼻炎患者的临床症状。     

支气管哮喘特异性免疫治疗与变应原疫苗的研究进展

特异性免疫治疗(SIT)被认为是目前唯一哮喘病因治疗方法，通过基因工程技术获得纯化和标准化重组变应原能取代传统的天然变应原浸液，具有较好的免疫原性，能增强治疗的疗效。本文就近几年哮喘特异性免疫治疗与变应原疫苗研究中新进展进行回顾总结。     

支气管哮喘特异性免疫治疗与变应原疫苗的研究进展

特异性免疫治疗 (SIT)被认为是目前唯一哮喘病因治疗方法 ,通过基因工程技术获得纯化和标准化重组变应原能取代传统的天然变应原浸液 ,具有较好的免疫原性 ,能增强治疗的疗效。本文就近几年哮喘特异性免疫治疗与变应原疫苗研究中新进展进行回顾总结。     

变应原浸出液免疫治疗的研究进展

变应原浸出液免疫治疗主要用于治疗过敏性哮喘、鼻炎和蜂毒过敏,有效率60～90%左右。其治疗机理可能与阻滞性抗体产生、抑制IgE 合成、抑制性细胞的产生等有关。免疫治疗的不良反应很少,但偶有因过敏反应致死者。近年来,在过敏原浸出液的标准化及改进给药途径上都取得了可喜的进展,推动了免疫治疗在临床的应用。     

变应原特异性免疫治疗的研究进展

变应原特异性免疫治疗(Allergen-specific immunotherapy, ASIT)是现阶段唯一针对病因治疗且能长时间持续减轻过敏症状,改变自然病程的治疗方法。目前已在过敏性疾病的临床治疗中广泛应用,并取得良好的治疗效果。随着治疗药物和治疗途径的不断改良,ASIT在过敏性疾病的治疗中显示出不可比拟的优势。本文对ASIT作用机制、应用药物、给药途径和禁忌症方面进行综述,旨在为ASIT的临床治疗提供参考。     

真菌变应原疫苗治疗变应性支气管哮喘的临床研究

目的 评价真菌疫苗特异性免疫治疗变应性支气管哮喘(简称哮喘)的临床疗效.方法 选择60例真菌过敏的轻、中度哮喘患者临床观察1年,治疗组(36例)和对照组(24例)分别皮下注射真菌变应原疫苗和盐酸组胺.观察治疗前后症状评分、用药计分、PD20-FEV1、PEF、FEV1pred%等指标.并进行统计分析.结果 两组治疗后症状评分均有所下降,但差异无统计学意义;与治疗前比较治疗组补救药物计分下降,PD20-FEV1增加,差异有统计学意义(P<0.01);两组PEF、FEV1pred%较治疗前差异均无统计学意义.治疗期间未发生一例严重不良反应事件.结论 对轻至中度的哮喘患者用真菌变应原疫苗进行特异性免疫治疗有效、安全.     

真菌变应原疫苗治疗变应性支气管哮喘的临床研究

目的评价真菌疫苗特异性免疫治疗变应性支气管哮喘（简称哮喘）的临床疗效。方法选择60例真菌过敏的轻、中度哮喘患者临床观察一年,治疗组（36例）和对照组（24例）分别皮下注射真菌变应原疫苗和盐酸组胺。观察治疗前后症状评分、用药计分、PD20FEV1、PEF、FEV1pred%等指标。并进行统计分析。结果两组治疗后症状评分均有所下降,但差异无统计学意义;与治疗前比较治疗组补救药物计分下降,PD23FEV1增加,差异有统计学意义（P〈0．01）;两组PEF、FEV1pred％较治疗前差异均无统计学意义。治疗期间未发生一例严重不良反应事件。结论对轻至中度的哮喘患者用真菌变应原疫苗进行特异性免疫治疗有效、安全。     

支气管哮喘合并过敏性鼻炎的临床治疗观察

目的了解布地奈德鼻喷剂联合舒利迭吸入剂对过敏性鼻炎-哮喘综合症患者的治疗效果。方法60例过敏性鼻炎-哮喘综合症患者,随机分为两组,对照组30例,给予吸入舒利迭50/100μg或50/250μg,1吸/次,2次/日。试验组30例,在吸入舒利迭治疗基础上,同时给予布地奈德鼻喷剂治疗,每个鼻孔各1喷,64μg/喷,2次/日。治疗时间为8周。结果试验组比对照组能显著提高患者的生存质量,对照组不能有效改善患者的鼻炎症状。结论联合治疗过敏性鼻炎和支气管哮喘比单纯治疗支气管哮喘更能有效地提高患者的生存质量。     

尘螨变应原诊断和免疫治疗哮喘与鼻炎安全性分析

目的: 回顾性调查粉尘螨(Derm atophagoidesfarinae)变应原诊断和免疫治疗哮喘及过敏性鼻炎的安全性。方法:问卷评估1974～1995 年用粉尘螨变应原(SMU-Df)诊断和免疫治疗变态反应的安全性。结果:统计分析846 342 例次。全身性不良反应共发生142 例次, 总发生率为1.68(CL= 1.4～2.0); 依次为全身性荨麻疹0.82、哮喘大发作0.77、过敏性休克0.07(CL= 1.4/百万～12.0/百万)、血管神经性水肿0.02。出现即时全身性反应在皮试或注射后30 m in 内有32例次,1 h 和2 h 各6 例次; 后期反应3 h～48 h 有88 例次, 以哮喘大发作的机率最高。发生的时期在皮试时共有18 例次,免疫递增期96例次, 维持期14 例次。共有6 例次过敏性休克立刻处理, 全部缓解。41 例次全身性反应的原因, 多半是在哮喘发作期或由于差错注射浓度过大及剂量过大。结论:22 年应用SMU-Df皮试和免疫皮下注射治疗,证明其疗效及安全性均高     

变应性鼻炎与支气管哮喘患者的肺功能改变

目的 通过对变应性鼻炎(A组)与支气管哮喘患者(B组)及健康对照组(C组)进行肺功能检测,寻找两种疾病肺功能改变的意义.方法 采用美国Sensor-Medics6200体描箱对A、B、C组患者检测肺功能有关指标.结果 A、B两组V25％ 、V50％明显降低,与C组比较,差异显著(P＜0.01);A组V50％与B组比较,有意义地增高(P＜0.05);B组RV明显增高,与A、C组比较,差异显著(P＜0.01);A、B两组Raw与C组比较,有意义地增高(P ＜0.05);FVE1％:B组低于C组(P＜0.05),而A组与C组及A组与B组对照均无明显差异(P＞0.05);DLCO％:B组高于A及C两组(P＜0.05).结论 两组患者对肺功能影响相似,主要是小气道阻塞,只是哮喘组影响强.     

广东惠州地区成人支气管哮喘合并过敏性鼻炎的流行病学调查分析

目的了解惠州地区支气管哮喘（简称哮喘）患者合并过敏性鼻炎的情况,分析两者在临床表现方面的相关性及调查对过敏性鼻炎认知程度和治疗现状。方法问卷调查惠州地区280例哮喘患者,详细了解其哮喘病史、严重程度分级、哮喘控制测试（asthma control test,ACT）评分、鼻炎情况包括患病情况、认知程度、相关家族遗传史及治疗现状等。建立相应个人数据档案,对数据进行统计学分析。结果 280例哮喘患者中,203例（72.50%）合并过敏性鼻炎,哮喘合并过敏性鼻炎组和单纯哮喘组在年龄、性别、病程间的差异无统计学意义（P〉0.05）。哮喘合并过敏性鼻炎组、二级（轻度持续）、三级（中度持续）、四级（重度持续）例数均高于单纯哮喘组（P〈0.05）。ACT评分,完全控制、良好控制例数均低于单纯哮喘组（P〈0.05）,未控制哮喘高于单纯哮喘组（P〈0.05）。鼻炎情况过敏性鼻炎起病早于哮喘占59.61%,两者同时起病占17.24%,鼻炎诱因依次为冷空气（82.10%）,刺激性气体（61.58%）,25.62%患者做过过敏原测验,56.65%使用药物治疗鼻炎,27.10%直系三代有哮喘或过敏性鼻炎家族史。结论惠州地区哮喘合并过敏性鼻炎发生率高,认知程度较低,治疗现状不容乐观,为今后防治措施及相关研究提供依据。     

广东惠州地区成人支气管哮喘合并过敏性鼻炎的流行病学调查分析

目的 了解惠州地区支气管哮喘(简称哮喘)患者合并过敏性鼻炎的情况,分析两者在临床表现方面的相关性及调查对过敏性鼻炎认知程度和治疗现状.方法 问卷凋查惠州地区280例哮喘患者,详细了解其哮喘病史、严重程度分级、哮喘控制测试(asthma control test,ACT)评分、鼻炎情况包括患病情况、认知程度、相关家族遗传史及治疗现状等.建立相应个人数据档案,对数据进行统计学分析.结果 280例哮喘患者中,203例(72.50％)合并过敏性鼻炎,哮喘合并过敏性鼻炎组和单纯哮喘组在年龄、性别、病程间的差异无统计学意义(P＞0.05).哮喘合并过敏性鼻炎组、二级(轻度持续)、三级(中度持续)、四级(重度持续)例数均高于单纯哮喘组(P＜0.05).ACT评分,完全控制、良好控制例数均低于单纯哮喘组(P＜0.05),未控制哮喘高于单纯哮喘组(P＜0.05).鼻炎情况过敏性鼻炎起病早于哮喘占59.61％,两者同时起病占17.24％,鼻炎诱因依次为冷空气(82.10％),刺激性气体(61.58％),25.62％患者做过过敏原测验,56.65％使用药物治疗鼻炎,27.10％直系三代有哮喘或过敏性鼻炎家族史.结论 惠州地区哮喘合并过敏性鼻炎发生率高,认知程度较低,治疗现状不容乐观,为今后防治措施及相关研究提供依据.     

支气管哮喘和变应性鼻炎的舌下特异性免疫疗法进展

舌下特异性免疫疗法在支气管哮喘和变应性鼻炎的治疗方面发挥了重要作用,它提供了一种可以替代传统皮下免疫疗法的变应原免疫治疗方法.目前已经有两种制剂(滴剂和片剂)可以用于舌下特异性免疫疗法.研究表明舌下特异性免疫疗法是安全、有效的.     

支气管哮喘和变应性鼻炎的舌下特异性免疫疗法进展

舌下特异性免疫疗法在支气管哮喘和变应性鼻炎的治疗方面发挥了重要作用,它提供了一种可以替代传统皮下免疫疗法的变应原免疫治疗方法。目前已经有两种制剂（滴剂和片剂）可以用于舌下特异性免疫疗法。研究表明舌下特异性免疫疗法是安全、有效的。     

The role of active B cells in allergen immunotherapy

BackgroundThe purpose of this study is to examine the changes in B lymphocyte subsets in patients receiving allergen immunotherapy.MethodsB lymphocyte subsets of patients before immunotherapy and one year after immunotherapy began were examined using the flow cytometric method. Age-matched healthy children served as the control group.ResultsTwenty-two patients with asthma and/or allergic rhinitis and 14 healthy, age-matched controls were included in the study. The median age of the patients was 13 years old (range: 6–20 years), and eleven (50.0%) were male. The median age of the healthy controls was also 13 years old (range: 7–17), and seven (50.0%) were male. In the age group from 11 to 15 years; the patients’ relative and absolute counts of active and mature sensitive B cells were higher than those of the healthy children (p = 0.027–0.012 and p = 0.032–0.010, respectively) before immunotherapy. The relative and absolute counts of active B cells before immunotherapy were also significantly higher than those of after immunotherapy (p = 0.001–0.001, p = 0.025–0.037, and p = 0.029–0.035, respectively). Before immunotherapy, the relative and absolute counts of mature sensitive B cells were significantly higher than those obtained after immunotherapy (p = 0.024–0.006) in the 11–15-year-old age group.ConclusionsAllergen immunotherapy directly influences B cell differentiation and causes a decrease in the count of active B cells. This finding is relevant because the B cell count can be used as a guide in the assessment of an individual patient's treatment response and also when determining whether to continue the immunotherapy.     

天津地区支气管哮喘合并过敏性鼻炎的流行病学调查及肺功能分析

目的 了解天津地区支气管哮喘(简称哮喘)合并过敏性鼻炎(allergic rhinitis,AR)的流行病学情况,分析两者之间的临床相关性及对肺功能的影响.方法 对天津地区142例哮喘患者进行哮喘合并过敏性鼻炎流行病学问卷调查及肺功能测定,了解患者的认知情况、治疗现状和肺功能状况,并建立相应的个人数据库档案,对数据进行统计学分析.结果 142例哮喘患者中,有97例合并过敏性鼻炎(68％),其中60例为鼻炎发病在先,占哮喘合并鼻炎患者的61.9％.哮喘合并鼻炎组和单纯哮喘组两组患者在性别、年龄和哮喘病史方面比较差异无统计学意义(P＞0.05),但哮喘合并鼻炎组的组间比较显示鼻炎史显著长于哮喘史,差异有统计学意义(P＜0.05).与单纯哮喘组相比,鼻炎合并哮喘组的哮喘控制测试(asthma control test,ACT)评分明显偏低,差异有统计学意义(P＜0.05).与单纯哮喘组相比,哮喘合并鼻炎组患者的呼气峰流速(peak expirationg flow,PEF)显著下降,吸入性糖皮质激素量减低,小气道敏感指标肺活量为75％时最大呼气流量(MEF75％)和MEF50％显著降低,而脉冲振荡频率在20 Hz时呼吸阻力(R20)增高.过敏性鼻炎与哮喘严重程度呈明显的正相关(rs=0.604,P＜0.01).结论 过敏性鼻炎多在哮喘之前发生,其与哮喘严重程度具有高度的一致性,是引发哮喘的一项重要危险因素.哮喘合并过敏性鼻炎患者的ACT评分显著低于单纯哮喘患者,并且过敏性鼻炎进一步导致了肺通气功能的下降及气道阻力增加,提高了哮喘的控制难度.     

The efficacy and safety of sublingual immunotherapy in children and adult patients with allergic rhinitis

BackgroundClinical research has shown that sublingual immunotherapy (SLIT) is effective and safe in moderate-severe allergic rhinitis (AR) induced by house dust mite (HDM). However, the sample size in many studies is small. Meanwhile, the controversy on the efficacy and safety in the very young children younger than four years old still existed.ObjectiveThe aim of this retrospective study is to evaluate the efficacy and safety of SLIT with Dermatophagoides farinae (Der.f) extracts in children and adult patients with allergic rhinitis, particularly in the very young children.MethodA total of 573 subjects aged 3–69 with AR received a three-year course of sublingual immunotherapy with Der.f extracts along with pharmacotherapy. The total nasal symptoms score (TNSS), total medication score (TMS), visual analogue score (VAS) and adverse events (AEs) were evaluated at each visit.ResultTNSS, TMS, VAS were significantly improved during the three-year course of treatment in comparison to the baseline values (P < 0.01). Besides, significant improvement in nasal symptoms and reduction of medication use were also observed in young children aged 3–6 years (P < 0.01). No severe systemic adverse events (AEs) were reported.ConclusionSLIT with Der.f drops is clinically effective and safe in children and adult patients with HDM-induced AR, including the very young children less than four years old.     

Safety,tolerability and clinical efficacy of ultra-rush sublingual immunotherapy among patients suffering from allergic rhinitis

BackgroundConventional immunotherapy for allergy with 3–5 years of treatment period has poor compliance. Ultra-rush sublingual immunotherapy with a shorter period of treatment can have better compliance. There are very few studies on ultra-rush sublingual immunotherapy all over the world.Objectives(1) To determine allergen sensitivity among allergic rhinitis patients. (2) To assess safety, tolerability and clinical efficacy of ultra-rush sublingual immunotherapy.MethodsThe present study was conducted in Allergy clinic, KIMS Hospital & Research Centre, Bangalore, India from January 2010 to June 2011. After obtaining Institutional Ethics Committee approval, 40 allergic rhinitis patients (according to ARIA guidelines) in the 18–60 years age group who were positive for aeroallergens in skin prick test were recruited for ultra-rush sublingual immunotherapy (20 min initial phase and 4-month maintenance phase) and followed for 8 months with symptom and treatment diary.ResultsOut of 40 patients, the majority, 36 (90.00%) patients were sensitive to house dust mites. Six patients had seven immediate adverse reactions and seven patients had eight delayed adverse reactions. All subsided without medication or with symptomatic oral medications. All patients tolerated ultra-rush SLIT and there was significant decrease in both symptom-score and treatment received in these patients.ConclusionUltra-rush SLIT regimen has excellent safety, tolerability and clinical efficacy among allergic rhinitis patients.