抗IgE治疗与皮下免疫治疗在儿童过敏性哮喘中的联合应用

Combined application of anti-IgE therapy and subcutaneous immunotherapy in children with allergic asthma

目的分析奥马珠单抗与皮下免疫治疗(SCIT)联合应用对过敏性哮喘患儿临床症状改善及免疫治疗耐受性的影响。方法回顾性分析2018年7月至2020年8月就诊于天津医科大学第二医院儿科哮喘专病门诊并接受奥马珠单抗联合双螨SCIT的哮喘患儿9例。比较基线期与联合治疗后患儿哮喘症状、肺功能、呼出气一氧化氮(FeNO)、生活质量评分、吸入性糖皮质激素(ICS)用量、合并症的改善情况及免疫治疗期间不良反应的发生情况。结果在ICS减量或维持原剂量的情况下,9例患儿的儿童哮喘控制测试/哮喘控制测试(C-ACT/ACT)和儿童哮喘生活质量评分(PAQLQ)均较治疗前有所改善。共患病包括鼻炎和湿疹,鼻炎视觉模拟评分(VAS)、儿童鼻结膜炎生活质量评分(PRQLQ)及湿疹严重程度评分(SCORAD)均较治疗前有所改善。免疫治疗期间患儿均未出现全身不良反应,有4例患儿分别出现1次(2例)、3次(1例)、8次(1例)局部不良反应。出现速发局部不良反应的注射次数仅占2.6%(3/116次),出现迟发局部不良反应的次数占8.6%(10/116次),其中出现局部红肿或硬结直径>4 cm的次数仅占2.6%(3/116次)。结论抗IgE治疗与SCIT联合应用可有效改善哮喘患儿症状、提高生活质量、减少急性发作次数及减少ICS用量,对于共患病的改善也有一定疗效。同时,抗IgE的加用可提高SCIT的耐受性和依从性。

Objective To analyze the effects of the combined applications of Omalizumab and subcutaneous immunotherapy(SCIT)in improving clinical symptoms and immunotherapy tolerance in children with allergic asthma.Methods A total of 9 children with asthma who received Omalizumab combined with SCIT in the Pediatrics Asthma Clinic of the Second Hospital of Tianjin Medical University from July 2018 to August 2020 were retrospectively analyzed.The symptoms of asthma,lung function,exhaled nitric oxide(FeNO),life quality scores,inhaled corticosteroids(ICS)dosage,comorbidities improvement,and adverse reactions during SCIT were analyzed and compared before and after the combined treatment.Results After treatment,both the scores of children asthma control test/asthma control test(C-ACT/ACT)and pediatric asthma quality of life questionnaire(PAQLQ)improved in 9 patients with reduced or maintained doses of ICS.After treatment,comorbidities,including rhinitis and eczema,the scores of visual analogue scale(VAS)for rhinitis,pediatric rhinoconjunctivitis quality of life questionnaire(PRQLQ)and scoring atopic dermatitis(SCORAD)were all improved.During SCIT,all children didn′t have systemic adverse reactions,and 4 children had 1(2 cases),3(1 case),and 8(1 case)local adverse reactions,respectively.The number of rapid local adverse reactions accounts for only 2.6%(3/116 times),and the number of delayed local adverse reactions occupies 8.6%(10/116 times).Among them,the number of local adverse reactions accounts for only 2.6%(3/116 times),and the dia-meters of swelling or induration were more than 4 cm.Conclusions The combined applications of anti-IgE therapy and SCIT can effectively improve the symptoms and quality of life,and reduce asthma exacerbations and dosage of ICS in children with asthma.It also has certain effects on the improvement of comorbidities.At the same time,the addition of anti-IgE therapy can enhance the tolerance and compliance of SCIT.