儿童哮喘患者屋尘螨变应原集群免疫治疗与常规免疫治疗起始阶段的安全性

摘要

Objective To compare the incidence of adverse reaction and safety between cluster and conventional immunotherapy among Dermatophagoides pteronyssinus-allergic asthmatic children.Methods Data of adverse reactions was collected and analyzed retrospectively among 84 asthmatic children who were prescribed subcutaneous specific immunotherapy by using standardized Alutard SQ between 2013 and 2015.Fifty-five patients were prescribed conventional immunotherapy while 29 were prescribed cluster immunotherapy.The data of incidence,clinical manifestations,onset time of local and systemic adverse reactions,expectant treatment,and dosage adjustment was collected and compared to evaluate the safety of different regimens of dose-increasing.Results The incidence of local and systemic adverse reaction was 52.73％ (29/55,based on number of cases) or 6.46％ (56/867,based on number of injections) and 9.09％ (5/55,based on number of cases) or 1.04％ (9/867,based on number of injections) respectively in conventional immunotherapy group,whereas 58.62％ (17/29,based on number of cases) or 10.21％ (44/431,based on number of injections) and 24.14％ (7/29,based on number of cases) or 3.02％ (13/431,based on number of injections) respectively in cluster immunotherapy group.The difference of incidence of local or systemic adverse reaction was not significant statistically between the two groups (P＞0.05) during the initial stage (dose-increasing phase).The cluster group achieved the maintenance dose within 7 weeks,which is shorter compared to the conventional group.Conclusion The cluster immunotherapy with standardized Alutard SQ is one kind of safe treatment for asthmatic children with advantage of rapid achieving maintenance dose.%目的 观察对屋尘螨过敏的儿童哮喘患者进行常规免疫治疗和集群免疫治疗的不良反应,并对两种免疫治疗方法的安全性进行比较.方法 通过回顾性分析,观察2013-2015年期间就诊的对屋尘螨过敏的儿童哮喘患者,采用标准化屋尘螨变应原(安脱达)进行免疫治疗,其中常规免疫组55例,集群免疫组29例,观察不同治疗方式、不同注射剂量后局部不良反应(LRs)和全身不良反应(SRs)发生率、症状、发生时间及治疗处理方法、变应原制剂调整等,分析可能的危险因素及预防措施.结果 55例患者接受常规免疫总注射867针次,LRs发生率分别为6.46％(56针次/867针次)和52.73％(29例/55例),SRs发生率分别为1.04％(9针次/867针次)和9.09％(5例/55例);29例患者接受集群免疫总注射431针次,LRs发生率分别为10.21％(44针次/431针次)和58.62％(17例/29例),SRs发生率分别为3.02％(13针次/431针次)和24.14％(7例/29例).两种免疫治疗方法的不良反应发生率差异均无统计学意义(均P＞0.05).集群免疫治疗7周达维持剂量,剂量递增阶段较常规免疫治疗明显缩短.结论 对儿童哮喘患者采用标准化屋尘螨变应原(安脱达)进行集群免疫治疗是一种安全的治疗方法,较常规免疫治疗能够更快达到维持剂量.