特异性免疫疗法治疗儿童哮喘致严重全身不良反应与治疗分析  

Serious systemic adverse events associated with allergen-specific immunotherapy in children with asthma

作　　者：代丽[1] 黄英[2] 王莹[2] 韩环立[2] 李渠北[2] 蒋永惠[2] 

机构地区：[1]德阳市人民医院儿科,四川德阳618000 [2]重庆医科大学附属儿童医院呼吸科,重庆400014

出　　处：《中国当代儿科杂志》2014年第1期58-61,共4页Chinese Journal of Contemporary Pediatrics

基　　金："十一五"国家科技支撑计划(2007BAI24B05);重庆社区儿童哮喘预防与控制适宜技术研究(2009-2-226)

摘　　要：目的了解标准化屋尘螨变应原制剂免疫治疗儿童哮喘的严重全身不良反应与治疗分析。方法对2005年1月至2011年12月经标准化屋尘螨变应原免疫治疗的704例5—17岁哮喘患儿全身不良反应及严重全身不良反应发生及治疗情况进行回顾性分析。结果17．0％哮喘患儿（120／704）在行免疫治疗后发生全身不良反应，共计发生336例次，其中发生严重不良反应（3级）18例次（5．4％），无1例发生4级如过敏性休克等致命性全身不良反应。发生年龄主分布在5—11岁，发生时间主集中于6。8月份。18例次严重全身不良反应均于注射后即刻出现PEF值下降〉20％，主表现为荨麻疹、咳嗽和哮鸣音等，均为速发不良反应。所有发生严重不良反应患儿均立即予雾化吸入激素及短效B受体激动剂、口服抗组胺药、静脉推注地塞米松和（或）肌肉注射肾上腺素后，均很快缓解。结论特发性免疫疗法治疗儿童哮喘的严重不良反应发生率低，立即处理后转归良好。Objective To retrospectively assess serious systemic adverse effects of standardized dust-mite vaccine in children with asthma. Methods Medical records of 704 children （5-17 years in age） with asthma between January, 2005 and December, 2011 were reviewed. Serious systemic adverse events following treatment with a standardized dust-mite vaccine in these children were analyzed. Results A total of 336 systemic adverse reactions were observed in 17.0% （I 20/704） of the patients analyzed of these adverse reactions, 18 （5.4%） were serious （level 3）, 318 （94.6%） were not serious （below level 3）, and no single case of anaphylactic shock （level 4） was recorded. Systemic adverse events occurred most frequently in the 5 to 11-year age group and in the summer season （from June to August）. In the 18 severe cases, the peak expiratory flow （PEF） dropped by 20% immediately after the vaccine injection, and other major clinical symptoms included cough, wheezing and urticaria. All children with serious systemic adverse effects were given inhaled hormone and atomized short-acting beta agonists, oral antihistamines, intravenous dexamethasone and/or intramuscular adrenaline. After these treatments, the clinical symptoms were significantly relieved. Conclusions The rate of serious systemic adverse events following allergen-specific immunotherapy is relatively low in children with allergic asthma. Conventional medications are effective in managing these immunotherapy-associated adverse events.

关 键 词：特异性免疫治疗 全身不良反应 尘螨 哮喘 儿童 

分 类 号：R725.6[医药卫生—儿科]