Roy Sitesh R, Sigmon Justin R, Olivier Jake, Moffitt John E, Brown David A, Marshall Gailen D
Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA.
Ann Allergy Asthma Immunol. 2007 Jul;99(1):82-6. doi: 10.1016/S1081-1206(10)60626-6.
Large local reactions are not uncommon during allergen immunotherapy (AIT). Dosage adjustments after large local reactions are commonly instituted despite literature that suggests individual large local reactions do not seem to predict subsequent systemic reactions.
To investigate the relationship between large local reactions and the risk of systemic reactions to AIT.
Retrospective review of the AIT database of a large, multicenter allergy practice group was conducted between June 1, 2003, and May 31, 2005. Numbers of large local reactions in 258 patients who experienced systemic reactions to AIT were compared with 299 age-, sex-, and sensitivity-matched control patients who did not experience systemic reactions during AIT.
A total of 283 systemic reactions occurred in 258 patients during the surveillance period, which included 661,123 patient visits for 1,108,621 allergy injections. The systemic reaction rate was 0.043% of visits and 0.025% of injections. The large local reaction rate was 35.2% of visits and 19.5% of injections among systemic reactors compared with 8.9% of visits and 5.3% of injections in the controls (P < .001 each). Thus, the odds of experiencing large local reactions were significantly increased among systemic reactors.
Although AIT is a safe and effective immunomodulatory therapeutic option for the treatment of allergic diseases, patients with increased frequency of large local reactions may have increased risk for future systemic reactions. Identifying additional risk factors remains viable. Recognizing the relevance of frequent large local reactions is important for designing safer protocols for successful AIT in these patients.
在变应原免疫疗法（AIT）期间，局部大反应并不罕见。尽管有文献表明个体局部大反应似乎并不能预测随后的全身反应，但在出现局部大反应后通常会进行剂量调整。
研究局部大反应与AIT全身反应风险之间的关系。
对一个大型多中心过敏诊疗组2003年6月1日至2005年5月31日期间的AIT数据库进行回顾性分析。将258例发生AIT全身反应的患者的局部大反应次数与299例年龄、性别和敏感性匹配的对照患者进行比较，这些对照患者在AIT期间未发生全身反应。
在监测期间，258例患者共发生283次全身反应，包括1108621次过敏注射，涉及661123次患者就诊。全身反应发生率为就诊次数的0.043%，注射次数的0.025%。全身反应者中局部大反应发生率为就诊次数的35.2%，注射次数的19.5%，而对照组分别为8.9%和5.3%（P均<0.001）。因此，全身反应者发生局部大反应的几率显著增加。
尽管AIT是治疗过敏性疾病的一种安全有效的免疫调节治疗选择，但局部大反应频率增加的患者未来发生全身反应的风险可能会增加。确定其他风险因素仍然可行。认识到频繁发生局部大反应的相关性对于为这些患者设计更安全的成功AIT方案很重要。
