变应原特异性免疫治疗致全身不良反应的观察及防控管理

Observations and preventions of systemic adverse reactions caused by allergen-specific immunotherapy

目的:通过观察变应原特异性皮下免疫治疗(subcutaneous immunotherapy, SCIT)注射后出现的全身不良反应,分析危险因素及处理措施,以便更安全地实施SCIT。方法:对2017年1月至2020年12月在淄博市中心医院过敏门诊行SCIT后发生全身不良反应的病例资料进行回顾性分析。结果:在739例患者的16 337次注射中,共16例患者发生了18次全身不良反应,全身不良反应的发生率为2.2%,以皮肤、结膜和呼吸道症状为主,其中Ⅰ级6次,Ⅱ级8次,Ⅲ级4次。速发型反应16次,迟发型反应2次。发生在初始治疗剂量快速上升阶段和维持治疗阶段共17次。10岁以下儿童易发生全身不良反应,sIgE 4级以上的患者易发生重度全身不良反应。结论:全身不良反应多发生在初始治疗剂量快速上升阶段和维持治疗阶段,多为速发型反应,低龄、伴多种过敏性疾病、感染、接触变应原、剧烈运动、情绪应激等都是诱发全身不良反应的危险因素。医护人员应在每次注射前询问患者的病史以及与危险因素相关的生活史。根据患者的健康状况、前次注射时的反应等及时调整变应原剂量,提高临床对药物不良反应的预防、鉴别和处理能力。

OBJECTIVE To explore the systemic adverse reactions of subcutaneous immunotherapy(SCIT)and examine the potential risk factors and safety measures.METHODS From January 2017 to December 2020,retrospective review was conducted for 739 SCIT patients.Medical records of systemic adverse reactions were recorded.RESULTS Among a total of 16,337 injections, 16 cases had 18 bouts of systemic adverse reactions.The incidence of systemic adverse reactions was 2.2%.Skin, conjunctival and respiratory symptoms predominated.The frequency was grade I(n=6),grade II(n=8)and grade Ⅲ(n=4).And the reactions were immediate reactions(n=16)and delayed reactions(n=2).Seventeen systemic adverse reactions occurred in dose rapid rise and maintenance phases.Systemic adverse reactions occurred frequently in children aged under 10 years and severe reactions were prone to occur in patients with grade 4 or higher sIgE.CONCLUSION Occurring mostly in dose rapid rise and maintenance phases, systemic adverse reactions are generally immediate.Young age, various concurrent allergic diseases, infections, contact with allergens, strenuous exercise and emotional stress are all risk factors of inducing systemic adverse reactions.Clinicians should inquire about a patient’s medical and life histories related with risk factors before each injection.Allergen dose may be adjusted timely according to a patient’s health status and previous reaction.It is necessary to improve the clinical proficiency of preventing, identifying and managing adverse drug reactions.