Tankersley M S, Butler K K, Butler W K, Goetz D W
Allergy and Immunology Department, Wilford Hall Medical Center, Lackland AFB, Texas, USA.
J Allergy Clin Immunol. 2000 Nov;106(5):840-3. doi: 10.1067/mai.2000.110468.
The recent World Health Organization position paper on allergen immunotherapy states that local reactions to immunotherapy are not predictive of subsequent systemic reactions. Nevertheless, in clinical practice dose adjustment after local reactions continues to be recommended, presumably in an effort to prevent future systemic reactions.
We sought to determine whether dose adjustment versus no adjustment for local reactions during allergen immunotherapy influences the occurrence of subsequent systemic reactions.
In a single-site allergy clinic before October 1, 1997, local reactions after allergen vaccine injection resulted in adjustment of the subsequent dose. After October 1, 1997, no dose adjustments were made for immediate and late local reactions. For the same 9-month period before and after the change in local reaction dose-adjustment policy, systemic reaction rates were compared retrospectively. For individuals experiencing a systemic reaction, local reaction rates and local reactions immediately preceding a systemic reaction were also compared before and after the policy change.
Comparing the 9-month period (October 1996-June 1997) preceding the policy change and the 9 months (October 1997-June 1998) after the change in policy, the systemic reaction rates (0.80% and 1.01%, respectively) were not statistically different (P =.24). Among those experiencing a systemic reaction, the rate of local reactions was unchanged (7.3% and 4.7%, respectively; P =.07), and the rate of local reactions immediately preceding a systemic reaction did not increase (18.8% and 10.5%, respectively; P =.37). The sensitivity of a local reaction predicting a systemic reaction at the next immunotherapy dose was 15%.
A local reaction is a very insensitive predictor for a subsequent systemic reaction at the next allergen vaccine dose. Dose adjustment for most local reactions is unnecessary and may delay therapy, increase costs, and put the patient at increased risk of dose administration errors.
世界卫生组织最近关于变应原免疫疗法的立场文件指出，免疫疗法的局部反应不能预测随后的全身反应。然而，在临床实践中，仍建议在出现局部反应后调整剂量，大概是为了预防未来的全身反应。
我们试图确定在变应原免疫疗法期间，针对局部反应调整剂量与不调整剂量是否会影响随后全身反应的发生。
在1997年10月1日前的一家单中心过敏诊所，变应原疫苗注射后的局部反应会导致后续剂量的调整。1997年10月1日后，对于即刻和迟发局部反应均不进行剂量调整。对局部反应剂量调整政策改变前后相同的9个月期间，回顾性比较全身反应发生率。对于发生全身反应的个体，还比较了政策改变前后的局部反应发生率以及全身反应前即刻的局部反应情况。
比较政策改变前的9个月期间（1996年10月至1997年6月）和政策改变后的9个月（1997年10月至1998年6月），全身反应发生率（分别为0.80%和1.01%）无统计学差异（P = 0.24）。在发生全身反应的患者中，局部反应发生率未改变（分别为7.3%和4.7%；P = 0.07），全身反应前即刻的局部反应发生率也未增加（分别为18.8%和10.5%；P = 0.37）。局部反应预测下一次免疫疗法剂量时发生全身反应的敏感性为15%。
局部反应对下一次变应原疫苗剂量时随后发生的全身反应预测性非常低。对大多数局部反应进行剂量调整是不必要的，可能会延误治疗、增加费用，并使患者面临更高的给药错误风险。
