摘要
Abstract
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 Altemaria alternata in 1 case. The intradermal skin test results of the patients were; + in 2 cases, + + in 9 cases, + + + in 12 cases, and + + + + in6 cases. 22 patients were also prescribed specificIgE 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.关键词
变应原免疫治疗/全身反应/临床观察Key words
allergen immunotherapy/ systemic reaction/ clinical observation分类
医药卫生
