局部变应性鼻炎屋尘螨皮下特异性免疫治疗的临床研究

A clinical study of dermatophagoides pteronyssinus specific subcutaneous immunotherapy against local allergic rhinitis

目的探讨屋尘螨皮下特异性免疫治疗在局部变应性鼻炎(LAR)治疗中的有效性和安全性。方法收集2015年12月~2016年12月耳鼻喉科门诊变应原皮肤点刺试验(SPT)和血清变应原特异性IgE检测(sIgE)均为阴性、屋尘螨变应原鼻黏膜激发试验(NAPT)阳性的26例LAR患者给予屋尘螨皮下特异性免疫治疗(SCIT),分别在治疗前、治疗6、12、18、24、36个月时进行症状评分、用药评分、生活质量评分、NAPT检查,对治疗前与治疗后的数据进行统计学分析,并观察治疗期间不良反应发生情况。结果22例患者完成了3年的免疫治疗,脱落了4例,SCIT治疗6、12、18、24、36个月时的症状总评分、用药评分、生活质量评分较治疗前均有降低,差异有统计学意义(P<0.05);治疗结束时100%(22/22)的观察组患者耐受了基线浓度的激发液、77%(17/22)的患者耐受了比基线浓度高10倍或以上浓度的激发液。使用同等浓度激发液,治疗结束时LAR患者激发试验鼻阻力、症状评分平均值均较治疗前下降,差异有统计学意义(P<0.05)。22例LAR患者3年共注射946次,其中严重局部不良反应发生率为0.42%(4/946),全身不良反应发生率为1.27%(12/946)。结论具有典型AR病史和症状,但SPT和血清sIgE阴性的患者,结合变应原NAPT检查阳性,可确诊为LAR。局部变应性鼻炎屋尘螨皮下特异性免疫治疗安全有效。

Objective To explore the effectiveness and safety of dermatophagoides pteronyssinus(DP)specific subcutaneous immunotherapy(SCIT)against local allergic rhinitis(LAR).Methods 26 LAR patients with negative result of allergen skin prick test(SPT)and serum allergen specific IgE test(sIgE)and positive result of DP NAPT in the outpatient service of Department of Otolaryngology from December 2015 to December 2016 were collected and given DP specific SCIT.The examination of symptom scores,medication scores,quality of life scores and NAPT was performed before treatment,6 m,12 m,18 m,24 m and 36 m after treatment respectively.The data before and after treatment were statistically analyzed,and the occurrence of adverse reactions(ADRs)during treatment was observed.Results 22 patients completed 3 years of immunotherapy and 4 patients broke away.The total symptom scores,medication scores and quality of life scores after 6 m,12 m,18 m,24 m and 36 m of SCIT treatment were all lower than those before treatment,and the differences were statistically significant(P<0.05);At the end of the treatment,100%(22/22)of the patients in the observation group tolerated the trigger with baseline concentration,and 77%(17/22)of the patients tolerated the trigger with a concentration 10 times or more higher than the baseline concentration.With the trigger of the same concentration being used,the provocation test nasal resistance and average symptom scores of the LAR patients at the end of treatment both decreased compared with those before treatment,and the differences were statistically significant(P<0.05).The 22 LAR patients were injected 946 times in 3 years,during which the incidence of severe local ADRs was 0.42%(4/946),and the incidence of systemic ADRs was 1.27%(12/946).Conclusion The patients with typical AR history and symptoms who have negative resultof SPT and serum sIgE combined with positive result of allergen NAPT can be diagnosed with LAR.DP specific SCIT against LAR is safe and effective.