舌下含服粉尘螨滴剂治疗支气管哮喘伴变应性鼻炎的疗效

Efficacy of Specific Sublingual Immunotherapy with Dermatophagoides Farinae Drops on Bronchitic Asthma and Allergic Rhinitis in Children

目的探讨舌下含服粉尘螨滴剂特异性免疫治疗支气管哮喘(哮喘)伴变应性鼻炎的疗效及安全性。方法选取516例年龄4～13岁哮喘伴变应性鼻炎患儿。其中291例完成1 a舌下免疫治疗(免疫治疗组),非免疫治疗对照组225例。患儿均完成10种常见变应原皮肤点刺试验,点刺试验结果呈阳性反应。免疫治疗组根据皮肤点刺试验结果分尘螨过敏组80例、尘螨及蟑螂过敏组71例、尘螨及花粉过敏组74例、尘螨及狗毛过敏组66例。应用粉尘螨滴剂进行临床免疫治疗,记录治疗前后哮喘控制问卷(ACQ)评分、鼻炎症状评分、用药情况和不良反应。结果 1.治疗12个月后,免疫治疗组和非免疫治疗对照组ACQ评分分别为(0.28±0.33)分和(1.07±0.68)分,与治疗前[(1.76±0.75)分和(1.55±0.62)分]比较,分别下降了(74.03±37.66)%和(29.32±44.53)%,2组ACQ评分比较差异有统计学意义(Z=-154.109,P<0.000 1)。2.治疗12个月,免疫治疗组和非免疫治疗对照组鼻炎症状评分分别为(0.337±0.479)分和(0.560±0.634)分,较治疗前[(0.899±0.667)分和(0.892±0.688)分]分别有70.8%和39.1%的患儿评分级别降低,2组比较差异有统计学意义(χ2=51.949,P<0.000 1)。3.治疗12个月,免疫治疗组和非免疫治疗对照组治疗哮喘月均用药评分分别为(20.91±18.03)分和(85.22±47.84)分,与治疗初始月均用药评分[(113.41±35.02)分和(108.86±35.24)分]比较,分别下降了(75.10±28.80)%和(20.60±39.52)%。4.治疗12个月,免疫治疗组肺功能呼气峰流速(预计值百分比)[(91.38±8.82)%]较治疗前上升(8.84±9.64)%。5.免疫治疗结束,免疫治疗组粉尘螨试验阳性级别降低,与非免疫治疗对照组比较差异有统计学意义(χ2=70.850,P<0.000 1)。6.各免疫治疗亚组ACQ评分、月均用药评分和粉尘螨皮试阳性级别降低的差异均无统计学意义。7.与用药相关的皮疹、鼻咽痒和哮喘发作不良反应发生率为24.7%,未出现过敏性休克等严重不良反应。结论特应性舌下免疫治疗方法安全有效,是治疗儿童哮喘伴变应性鼻炎的重要措施之一。

Objective To explore the efficacy and safety of specific sublingual immunotherapy with dermatophagoides farinae drops on bronchitic asthma and allergic rhinitis in children. Methods Five hundred and sixteen children aged 4-13 years old with asthma and allergic rhinitis were involved in the study.Among them,291 cases had received specific sublingual immunotherapy for 1 year（immunotherapy group） and the other（225 cases） had not received specific sublingual immunotherapy as control group.Skin prick test with 10 common allergens were taken in all subjects and positive reaction to dermatophagoides was confirmed.Immunotherapy group were assigned into 4 subgroups according to the results of skin prick test：only sensitized to mites group（80 cases）,sensitized to mites and cockroach group（71 cases）,sensitized to mites and pollen group（74 cases）,sensitized to mites and dog hair group（66 cases）.Dermatophagoides farinae drops（DFD） was used for sublingual immunotherapy.Asthma control questionnaire（ACQ） scores,rhinitis symptoms scores,drug use before and after treatment and side reaction were recorded. Results 1.After 12 months treatment of sublingual immunotherapy,the ACQ scores in immunotherapy group and control group were 0.28±0.33 and 1.07±0.68,and they were decreased separately by（74.03±37.66）% and（29.32±44.53）% compared with those before treatment（1.76±0.75 and 1.55±0.62）,which showed extremely significant decreased ACQ grading in the immunotherapy patients（Z=-154.109,P0.000 1）.2.After 12 months treatment of sublingual immunotherapy,the rhinitis symptoms scores in immunotherapy group and control group were 0.337±0.479 and 0.560±0.634,and they were decreased by 70.8% and 39.1% compared with those before treatment（0.899±0.667 and 0.892±0.688）,and there was significant difference between both groups（χ2=51.949,P0.000 1）.3.After 12 months treatment of sublingual immunotherapy,accumulation scores of asthmatic medicine used monthly in the immunotherapy group and the control group were 20.91±18.03 and 85.22±47.84 respectively,and they were decreased se-parately（75.10±28.80）% and（20.60±39.52）% compared with those of initial dosage（113.41±35.02 and 108.86±35.24）.4.After 12 months treatment of sublingual immunotherapy,in immunotherapy group,lung function peak expiratory flow（predicted value percentage） increased by（8.84±9.64）% to（91.38±8.82）% compared with that before the treatment.5.After treatment,positive reaction of skin prick test to dermatophagoides allergen in children with immunotherapy was reduced,which was statistically significant compared with control group（χ2=70.850,P0.000 1）.6.There was no statistical significance on the ACQ score,accumulation score of asthmatic medicine used monthly and the rank of positive reaction of skin prick test to dermatophagoides allergen reduced between different groups in immunotherapy group.7.The incidences of side reaction related to immunotherapy including skin rash and nasopharynx itches and asthma attack was 24.7%,while no anaphylactic shock happened. Conclusions Sublingual immunotherapy is effective and safe,which may be one of the most important means of treatment of allergy disease in children.