皮下免疫治疗注射后出现全身不良反应的伴发因素及处理

Factors associated with systemic adverse reactions after subcutaneous immunotherapy injections and treatment options

目的分析皮下免疫治疗(SCIT)注射后出现全身不良反应的伴发因素及处理方式,以便更安全实施SCIT治疗。方法回顾分析2013年1月至2017年12月在变应性疾病门诊行SCIT后出现全身变应反应的病例记录。结果 SCIT注射4597次(191例),出现全身不良反应共23次(21例),全身不良反应的发生率为0.5%,其中速发性反应17例,迟发性反应6例。出现于初始治疗阶段6例,维持治疗阶段17例。根据WAO免疫治疗指导文件进行分级,1级7例,2级15例,3级1例,4级0例,5级0例。排除伴发因素后继续原剂量注射,无不良反应发生。结论全身反应多在剂量维持期出现,饮酒、感染、食入或吸入大量变应原、热水浴、运动、疲劳、情绪应激、空腹、妊娠初期、存在其他的特异性IgE疾病等都是诱发患者对已多次注射、耐受良好的SCIT剂量出现全身不良反应的危险因素。每次注射前详细追问患者近期生活史及严格评定注射者是减少全身变应反应的重要环节。排除伴发因素后继续原剂量注射是安全的治疗方法。

Objective To analyze the factors associated with and the treatment of systemic adverse reactions after subcutaneous immunotherapy（ SCIT） injections. Methods We retrospectively analyzed the records of patients with systemic anaphylaxis who presented to the Allergic Diseases Outpatient Department between January 2013 and December 2017. Results A total of 4597 SCIT injections had been administered to 191 patients,and 23 cases/instances of systemic adverse reactions were reported in 21 patients.The incidence of systemic adverse reactions was 0.5%. An immediate reaction was observed in 17 and a delayed reaction was observed in 6 cases. Systemic adverse reactions occurred during the initial treatment in 6 and during maintenance treatment in 17 cases.Based on the World Allergy Organization immunotherapy guidelines,7 cases were classified as grade 1,15 as grade 2,1 as grade3,0 as grade 4,and 0 as grade 5. After exclusion of the associated factors,continuing to inject the original dose showed no adverse reactions. Conclusion Systemic reactions usually occur during the dose maintenance period. Alcohol intake,infections,ingestion or inhalation of a large number of allergens,hot water baths,exercise,fatigue,emotional stress,fasting,early pregnancy,and a fewspecific immunoglobulin E-mediated diseases are known risk factors for systemic adverse reactions in patients who receive multiple injections and tend to develop tolerance to the dose. Detailed questioning regarding the patient＇s recent life history prior to each injection and careful assessment of the injector are important to reduce systemic allergic reactions. Continuing to inject the original dose after excluding the contributory factors is safe.