变应原皮下注射免疫治疗致全身过敏反应的回顾性分析  

Retrospective study on systemic allergic reactions induced by subcutaneous allergen-specific immunotherapy

作　　者：王青[1] 李丽莎[1] 尹佳[1] 王良录[1] 支玉香[1] 孙劲旅[1] 关凯[1] 刘君[1] 郑杰 李宇[1] 支凡 WANG Qing;LI Lisha;YIN Jia;WANG Lianglu;ZHI Yuxiang;SUN Jinglyu;GUAN Kai;LIU Jun;ZHENG Jie;LI Yu;ZHI Fan(Department of Allergy,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases,National Clinical Research Center for Dermatologic and Immunologic Diseases,Peking Union Translational Medical Center,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院变态反应科,过敏性疾病精准诊疗研究北京市重点实验室,国家皮肤与免疫疾病临床医学研究中心,协和转化医学中心,北京100730

出　　处：《中华临床免疫和变态反应杂志》2024年第4期370-375,共6页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家自然科学基金(82070033);北京市自然科学基金(7222136);中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-017);中央高水平医院临床科研业务费(2022-PUMCH-B-089)。

摘　　要：目的回顾性分析变应原皮下注射免疫治疗(subcutaneous immunotherapy,SCIT)致全身过敏反应病例的临床特点,探讨中重度全身过敏反应的相关危险因素。方法本研究为单中心回顾性研究,收集2012—2022年间在北京协和医院变态反应科门诊发生SCIT相关速发型全身过敏反应的变应性鼻炎哮喘患者的病历资料,分析其人口学特征、临床诊断、SCIT所用变应原种类与浓度、SCIT致全身过敏反应的临床表现及治疗经过等信息,探索可能影响全身过敏反应严重程度的危险因素。结果2012—2022年间,北京协和医院变态反应科门诊共59例患者发生了72次SCIT致全身过敏反应,其中11例患者发生了多次全身过敏反应;患者诊断分别为变应性鼻炎者14例,哮喘者6例,变应性鼻炎合并哮喘者39例;根据世界过敏组织严重度分级,发生1级反应18次,2级反应46次,3级反应2次,4级反应6次,无致死事件;出现皮肤症状者占比72.2%,出现上下呼吸道症状者占比70.8%,循环系统受累者占比16.7%。轻症组(1级反应)患者皮下注射时的年龄显著低于中重症组(2~4级反应)[11(8,20)岁比24(9,35)岁,P=0.032]。结论在本研究所观察人群中,SCIT致全身过敏反应主要为轻中度,皮肤和呼吸道过敏症状是主要临床表现,年龄可能为影响全身反应严重程度的因素。Objective To analyze the clinical features of systemic allergic reactions induced by subcutaneous allergen-specific immunotherapy(SCIT)retrospectively and to explore risk factors related to moderate to severe systemic allergic reactions.Methods A single-center retrospective study was designed.The medical records of allergic rhinitis and/or asthma patients with SCIT-related immediate systemic allergic reactions were collected in Outpatient Clinic of Department of Allergy,Peking Union Medical College Hospital since 2012 to 2022.Demographic information,clinical diagnosis,formula and concentration of allergens extracts used in SCIT,clinical manifestations and treatment of systemic allergic reactions induced by SCIT and other information were summarized.Risk factors related to severity of systemic reactions were also investigated.Results A total of 59 patients experienced 72 systemic allergic reactions caused by SCIT and 11 of them experienced multiple reactions since 2012 to 2022.14 of them were diagnosed as single allergic rhinitis(AR),6 as single asthma and another 39 as AR with asthma.According to World Allergy Organization(WAO)classification of severity,18 GradeⅠ,46 GradeⅡ,2 GradeⅢand 6 GradeⅣreactions were recorded,whereas no fatal reaction occurred.Cutaneous symptoms occurred among 72.2%of patients,upper and lower respiratory symptoms among 70.8%and circulatory system symptoms among 16.7%of them.The average age of mild group(Grade I reaction)was 11(8,20)years-old,significantly younger than that of moderate and severe group(GradeⅡtoⅣreaction,P=0.032,which was 24(9,35))years-old.Conclusions Severity of systemic allergic reactions induced by SCIT was mainly mild to moderate among patient in this study,while cutaneous and respiratory allergic symptoms were the major clinical manifestations.Age might be a influencing factor related to severity of systemic reactions.

关 键 词：免疫治疗 变应原 皮下注射免疫治疗 全身过敏反应 严重程度 

分 类 号：R593.1[医药卫生—内科学]