变应原免疫治疗致全身反应

目的对变应原免疫治疗过程中发生的全身反应进行临床观察,以期找到其发生规律,便于及时发现、处理和预防。方法回顾近15年接受变应原免疫治疗（AIT）过程中出现全身反应的29例患者,依据反应发生时间与程度按欧洲变态反应和临床免疫学会（EAACI）分类标准分为4级。结果 29例患者均为吸入变应原致呼吸道过敏性疾病,在AIT过程中共出现59例次全身反应。29例患者中男女比例17：12,开始接受AIT的平均年龄为27.3岁（6～59岁）。吸入变应原致敏情况：夏秋花粉24例（蒿属花粉22例、葎草花粉1例、混合夏秋花粉1例）,蚕丝4例,交链孢霉1例。皮下注射后症状出现时间：≤20min占67.8%（40/59）,≤30min占84.7%（50/59）。59例次全身反应中,荨麻疹占55.9%（33/59）,哮喘占50.9%（30/59）,上呼吸道过敏症状占23.7%（14/59）,喉水肿占5.1%（3/59）,低血容量休克占1.7%（1/59）。全身反应中,较轻的Ⅰ类和Ⅱ类占76.3%（45/59）,较重的Ⅲ类和Ⅳ类均发生于皮下注射后15min内。结论全身反应严重程度与皮试反应强度无关。AIT注射后应留院密切观察,特别是前15min应予充分重视。

Systemic Reactions Induced by Allergen Specific Immunotherapy

Objective Systemic reactions induced by allergen specific immunotherapy（SIT） injections can be observed in clinical practice,which are rarely life-threaten but the most dangerous reactions.Summary of the clinical features will benefit to early recognition,adequate management and prevention of systemic reactions.Methods Systemic reactions were collected and reviewed from patients who were prescribed SIT by using aqueous allergen extracts during the past fifteen years from Department of Allergy,Peking Union Medical College Hospital.All systemic reactions were graded into level I to IV based on the grading system of EAACI Immunotherapy Position Paper,according to the onset and severity of clinical symptoms.Results 59 systemic reactions were collected from 29 respiratory allergic disease patients who were prescribed inhalant allergen SIT.17 of the patients are male,and 12 are female,whose average age of beginning of SIT was 27（6-59） years old.The inhalant allergens extracts used in SIT were：summer-autumnal weed pollens in 24 cases（including Artemisia pollen in 22,Humulus pollen in 1 and other weed pollen in 1 case）,silk in 4 cases and Alternaria alternata in 1 case.The intradermal skin test results of the patients were：＋ in 2 cases,＋＋ in 9 cases,＋＋＋ in 12 cases,and ＋＋＋＋ in 6 cases.22 patients were also prescribed specific IgE detection,whose results were 3.5-in 7 cases,17.5-in 4 cases,50-in 4 cases,and 100 kUA/L in 7 cases.51.7%（15/29） of first systemic reactions occurred in the phase of the dose increasing and 48.3%（14/29） in the phase of dose maintenance.The time gap between symptom onset and the injections was less than 20 minutes among 67.8% of patients,while less than 30 minutes among 84.7% of patients.The clinical features of systemic reactions were：urticaria（55.9%）,asthma（50.9%）,upper respiratory symptoms（23.7%） and others（6.8%） [including larynx edema（5.1%） and hypovolemic shock（1.7%）].76.3% of systemic reactions belonged to level Ⅰ and Ⅱ（mild and moderate reactions）.All level Ⅲ and Ⅳ（severe reactions and Anaphylactic shock） initiated within 15 minutes.26 patients continued SIT after adjusting doses although they were suffering from systematic reactions,whereas the other 3 patients withdrew from SIT.Conclusions There was no correlation between the severities of systemic reaction results of intradermal test.Close surveillance after SIT injections is very important for the prevention of systemic reaction,especially during the first 15 minutes.We strongly recommended that at least 30 minutes surveillance should be performed for high-risk patients,especially for patients with severe asthma.