舌下特异性免疫治疗前后哮喘患儿过敏原及血清总IgE的变化

Changes of serum IgE and skin prick tests after SLIT treatment in asthma children

目的分析粉尘螨滴剂舌下含服特异性免疫治疗(sublingual immunotherapy,SLIT)前后,哮喘患儿尘螨及其他过敏原皮肤点刺试验局部红斑直径改变以及血清总IgE变化情况,探讨粉尘螨滴剂免疫治疗在儿童过敏性哮喘脱敏治疗中的作用及时效性。方法收集本院2009年10月～2011年12月确诊哮喘并进行皮肤点刺试验及血清总IgE检测的患儿资料,所有患儿均予哮喘规范化吸入治疗,其中未加用SLIT者为对照组,加用SLIT维持6个月者为治疗6个月组,加用SLIT维持12个月者为治疗12个月组。检测入组前、完成治疗后血清总IgE值和过敏原皮试直径变化。结果研究结束共收集病例52例,其中对照组18例、治疗6个月组18例、治疗12个月组16例,入组前三组患儿皮肤点刺试验显示至少1种螨皮试反应≥(+++),其中粉尘螨、屋尘螨同时阳性者占82.58%(43/52),螨合并其他过敏原阳性者占63.46%(33/52),血清总IgE均大于同龄儿童正常值高限,平均升高(5.12±1.06)倍;治疗6个月组和治疗12月组疗程结束后螨、狗毛及蟑螂过敏原皮试直径较治疗前均有显著下降(P<0.01),治疗12个月组各种过敏原皮试直径均明显下降(猫毛、蒲公英、荨麻P<0.05,其他P<0.01);两组血清总IgE升高倍数在治疗后的下降幅度分别为(2.65±0.78)、(3.88±1.02),差异有高度统计学意义(P<0.01);对照组过敏原皮试直径和血清总IgE的变化无统计学意义(P>0.05)。结论粉尘螨滴剂舌下含服特异性免疫治疗可以有效抑制哮喘患儿对尘螨和其他常见吸入类过敏原的过敏反应,12个月疗程的脱敏效果明显优于6个月疗程。

Objective To analyze the changes of the skin prick test and serum IgE in the asthma children after dust mite sublingual immunotherapy（SLIT）,explore the value and the effective time of dust mite SLIT.Methods The children confirmed as asthma were recruited from October 2009 to December 2011 in our hospital.They were regular asthma treated.Children not involved SLIT were assigned to control group.Children with additional 6 monthes′ SLIT were assigned to therapy group 1（6 months′ therapy）.Children with additional 12 monthes′ SLIT were assigned to therapy group 2（12 months′ therapy）.All of them were taken both skin prick test and serum IgE test before and after the treatment.Results Of the 52 participants,18 were assigned to control group,18 to therapy group 1,16 to therapy group 2.Before treatment,all the individuals′ reaction to skin prink test showed at least one mite ≥（＋＋＋）.43 of 52 children（82.58%） showed positive reaction in both dust mite and house dust mite.33 of 52 children（63.46%） showed positive reaction in both mite and some other antigens.Serum IgE levels were（5.12±1.06） times higher than the healthy children.After 6 or 12 months′ treatment,the skin test′s diameters reduced significantly in mite,dog hair and cockroach（P 0.01）.After 12 months′ treatment,the skin test′s diameters reduced significantly in all the antigens（for cat hair,dandelion and nettle,P 0.05;for the rest antigens,P 0.01）.The serum IgE level reduced significantly（P 0.01）.The skin test′s diameters and serum IgE level didn′t change significantly in the control group（P 0.05）.Conclusion Dust mite SLIT may inhibit the allergy reaction to dust mite and the other inhalation antigens effectively.12 months′ therapy may better than 6 months′ therapy.