经皮下特异性免疫治疗的支气管哮喘和/或过敏性鼻炎患儿全身不良反应观察及危险因素分析

Systemic reactions to subcutaneous immunotherapy for bronchial asthma and/or allergic rhinitis in children and their risk factors

目的分析皮下特异性免疫治疗(SCIT)治疗儿童支气管哮喘和/或变应性鼻炎的全身不良反应(SR)的发生情况及危险因素。方法回顾性分析该院儿科收治的支气管哮喘和/或变应性鼻炎患儿198例为研究对象。根据所有患儿SCIT过程中SR和局部不良反应(LR)的发生情况,分为SR组(n=31)及对照组(未发生SR及LR的患儿,n=142),采用logistic多因素回归分析对发生SR的危险因素进行分析。结果在对198例患儿的8157次SCIT注射中,共有25(12.6%)例患儿发生31例次(0.38%)SR,其中Ⅰ级SR 18例次(58%),Ⅱ级SR 10例次(32%),Ⅲ级SR 3例次(10%),无Ⅳ级SR。多因素logistic回归分析显示同时合并食物及吸入过敏原的多重过敏、尘螨sIgE 6级、总IgE 6级、既往LR发生史是SR的独立危险因素(P<0.05)。结论SCIT治疗哮喘和/或过敏性鼻炎的SR发生率低,安全性良好。对同时合并食物及吸入过敏原的多重过敏、高敏状态(尘螨sIgE 6级、总IgE 6级)、既往局部不良反应发生史者需警惕SR发生。[中国当代儿科杂志,2020,22(11):1204-1208]

Objective To investigate the incidence of systemic reactions(SR)to subcutaneous immunotherapy(SCIT)for bronchial asthma and/or allergic rhinitis in children and their risk factors.Methods A retrospective analysis was performed on 198 children with bronchial and/or allergic rhinitis.According to the presence or absence of SR and local reactions(LR)during SCIT,the patients were divided into two groups:SR(with SR and LR,n=31)and control(without SR or LR,n=142).A multivariate logistic regression analysis was used to determine the risk factors associated with SR.Results Among the 198 patients who received 8?157 injections of SCIT,25(12.6%)experienced SR(31 times,0.38%),including grade I SR(18 times,58%),grade II SR(10 times,32%),grade III SR(3 times,10%),and no grade IV SR.The multivariate logistic regression analysis showed that multiple sensitization with both food and inhaled allergens,specific IgE to dust mites(grade 6),total IgE(grade 6),and a history of LR were independent risk factors for SR(P<0.05).Conclusions SCIT is a safe treatment for bronchial asthma and/or allergic rhinitis in children,with a low incidence of SR.Children with multiple sensitization with both food and inhaled allergens,a hypersensitive state(specific IgE to dust mites,grade 6;total IgE,grade 6),and a history of LR have an increased risk of SR to SCIT.[Chin J Contemp Pediatr,2020,22(11):1204-1208]