免疫疗法致不良反应的临床观察——附29例报告

Clinical observation of adverse reactions to allergen immunotherapy:Twenty-nine cases report

本文对 1999年 8月～ 2 0 0 0年 8月在接受免疫疗法 (AIT)的患者中 ,观察到 2 9例发生了不良反应 ,以例次计 ,风团 12例 ,局部反应 16例、大局部反应 16例、非致死性全身性反应 12例。对他们进行了追踪观察。结果发现 95 .5 %的局部反应发生于≤ 10 4 的浓度。约 75 %的局部和大局部反应发生于剂量≥ 0 .6。虽然大多数局部和大局部反应随着剂量的增加逐渐减小或消失 ,但有一部分继续进展为较重的反应 ,特别是有大局部反应的 16例中 ,有 3例进展为非致死性全身性反应。因此 ,对任何局部反应都不能掉以轻心。全身性反应除 1例发生于注射后 30min外 ,其余均发生于 15min内。诱发的症状有哮喘、变应性眼鼻炎、全身性荨麻疹等 ,1例伴原因不明轻憋。结论 :开始AIT前 ,正确掌握适应症和选好吸入变应原 ,并慎重制订正确的治疗方案 ,加强随访和向患者说明可能发生的反应以及告诉患者出现反应后的一般处理方法 。

Fifty six adverse reactions occurred in 29 patients receiving allergen immunotherapy is followed up in this study, including wheals in 12 cases, local reaction in 16 cases,large local reaction 16 cases,systemic reaction in 6(12 times)cases. Results 95.5% of local reactions occured in allergen concentration ≤10 4 . Seventy five percent of local and large local reactions occurred in dose 0.6ml or more. Although most of the local and large local reactions will decrease or disappeare with the dose increasing, part of them will still develope to large ones. Three of the large local reactions developed systemic reactions. Therefore, more attention should be paid to these reactions. Most of the nonfatal systemic reactions occured within 3 15 min, only one at 30min after allergen injection. Symptoms included wheezing, nasal and eye's uncomfortable, and general urticaria. Conclusion Before AIT,indication and allergens should be selected properly,and therapeutic schedule should be worked out correctly, then we should follow up these patients closely. All of these are very important for decreasing the adverse reactions.