尘螨变应性哮喘患儿对标准化螨提取液特异性免疫治疗的耐受性及依从性

Tolerance and Compliance of Asthmatic Children for Specific Immunotherapy with Standardized House-Dust Mite Extract Therapy

目的探讨变应性哮喘患儿对标准化尘螨提取液特异性免疫治疗的耐受性及依从性。方法对无锡市儿童医院哮喘专科临床诊断为哮喘51例患儿,应用标准化屋尘螨提取液皮下注射,进行特异性免疫治疗33周,观察剂量递增阶段和维持阶段每次免疫注射后速发和迟发不良反应发生情况,在每次变应原注射前和注射后30 m in测其呼吸峰流速值(PEF),总结不良反应事件发生的原因,分析患儿对治疗的依从性。结果剂量递增阶段(50例)和维持阶段(46例)患儿免疫注射总次数为992例次。其中32例(62.75%)发生150例次(15.12%)速发不良反应,136例次为轻度局部反应(肿胀直径<5 cm),14例次为轻度全身反应;23例(45.10%)发生42例次(4.23%)迟发不良反应,1例次中度哮喘,2例次变应性皮炎,其余均为轻度局部反应。各次免疫注射前后PEF变化率的差异无统计学意义(χ2=18.06 P=0.42)。51例中5例中途退出(9.80%),其中1例于剂量递增阶段(22周)不能耐受退出,4例于维持阶段退出。结论尘螨变应性哮喘患儿对标准化屋尘螨提取液特异性免疫治疗耐受性、依从性良好,轻度局部不良反应多见,全身不良反应均为轻度。各次免疫注射对肺通气功能无显著影响。

Objective To explore the tolerance and compliance during the phase of specific immunotherapy with standardized house - dust mite extract in asthmatic children. Methods Subcutaneous specific immunotherapy with standardized house - dust mite extract was administrated to 51 asthmatic children with allergy to house - dust mite for 33 weeks. The immediate and delayed side - effects after each allergen injection during dose - increase and maintenance phase of immunotherapy treatment were monitored. Peak expiratory flow range was measure before and 30 minutes after each injection for every patient. The compliance of patient to immunotherapy treatment was analyzed. Results A total of 992 injections were completed during dose -increase（50 cases） and maintenance period（46 cases）. As a result, 150 injections （15.12%） caused immediate side -effects within 30 minutes after injection in 32 patients（62.75% ） ,in which 136 side - effects were mild local reactions（ 〈5 em in diameter） and 14 side - effects were mild systemic reactions. Twenty - three patients （45.10%） reported 42 delayed side -effects （4.23%） 30 minutes after injection,3 delayed side effects which occurred in 3 patients were mild systemic reactions, which included asthma, allergy dermatitis, and all those systemic reactions respond well to ordinary treatment. There were no distinct difference of measured peak expiratory flow range between before and 30 minutes after each injection for each child （x^2 = 18.06 P = 0.42 ）. One dropped out because of poor tolerance during dose -increase period （22 weeks） ,while 50 subjects completed dose -increase period of immunotherapy treatment successfully, and 4 dropped out during maintenance period because of poor tolerance （1 subject） and poor compliance （3 subjects）, respectively. Conclusions Subcutaneous specific immunotherapy with standardized house -dust mite extract show a good tolerance and compliance in asthmatic children. No significant change of lung function is observed during dose - increase and maintenance phase of specific immunotherapy.