特应性舌下免疫治疗儿童哮喘并变应性鼻炎的临床研究

Clinic study of specific sublingual immunotherapy in children with asthma and allergic rhinitis

目的探讨舌下舍服尘螨变应原疫苗治疗儿童哮喘的临床疗效和免疫指标变化。方法选取年龄4～13岁哮喘缓解期伴变应性鼻炎患儿300例为免疫治疗对象，完成包括粉尘螨在内的10种常见过敏原皮肤点刺实验，点刺试验结果呈阳性反应。全部患者肺功能检查在个人预计值正常值范围。应用粉尘螨滴剂进行临床免疫治疗，记录治疗前后症状和体征评分和不良反应。采用夹心酶联免疫吸附测定方法检测治疗前后血清尘螨免疫球蛋白E（sIgE）和特异性IgG4。结果进入治疗的300例儿童哮喘并变应性鼻炎患儿坚持完成1年治疗的有221例，治疗总有效率为71．0％，有效病例中平均起效时间为6．8月（中位时间6个月）。与用药相关的皮疹，鼻咽痒和哮喘发作的不良反应发生率21．7％（48／221），未出现过敏性休克的严重不良反应。儿童哮喘并变应性鼻炎患者血清sIgE治疗前（125．21±96．70）kU／L，治疗后（121．19±87．01）kU／L，治疗前后比较无明显变化（t=0．913，P〉0．05）；血清特异性IgG4治疗后（894．2±687．1）kU／i。比治疗前（696．7±452．8）kU／L明显升高（t=3．519，P〈0．01）。结论特应性舌下费．癌治疗方法安全有效，是治疗儿童变应性疾病的重要措施之一。

Objective To explore the etticacy and satety ot the specitic sublingual lmmunotherapy in children with stable asthma and allergic rhinitis and change of immunity parameters. Methods Three hundred cases of children in four to thirteen years old with asthma in remission stage and allergic rhinitis were involved in the study. Skin prick test with ten common allergens including dermatophagoides were taken in children and positive reaction to dermatophagoides was confirmed. Lung functions in all children were in predicted normal value scope. ＂Dermatophagoides farinae drips（DFD）＂ provided by Wolwo Biotech Co, Ltd. in Zhejiang Province was used for special sublingual immunotherapy. Clinic symptom score before and after treatment and side reaction were recorded. The concentrations of serum dermatophagoides farinae specific IgE and IgG4 were measured with ELISA method. Results Two hundred and twenty-one patients out of 300 cases of children with asthma in remission stage and allergic rhinitis completed one year study. The clinic effective rate of desensitization with DFD was 71.0%. The average effect time in effective cases of children with asthma and allergic rhinitis was 6.8 months （median 6 months）. Frequency of occurrence of side reaction related to immunotherapy including skin rash and nasopharynx itches and asthma attack was 21.7%（48/221）, while no allergic shock happened. There was no significant decrease of serum dermatophagoides farinae specific IgE after immunotherapy （121.19 ± 87.01） kU/L compared with that pre-immunotherapy （ 125.21 ± 96.70） kU/L in the children themselves（ t =0. 913, P 〉0.05）. While significant increase of serum specific IgG4 was found after immunotherapy （894.2±687.1） kU/L compared to that pre immunotherapy （696.7±452.8） kU/L in the patients themselves（ t =3. 519, P d0.01）. Conclusion Sublingual immunotherapy method is effective and safe,it may be one of the most important means of treatment for allergy disease in children.