Serrano Pilar, Justicia José-Luis, Sánchez Cesárea, Cimarra Mercedes, Fernández-Távora Laureano, Orovitg Agustín, Moreno Carmen, Guerra Francisco, Alvà Víctor
Allergy Service, Hospital Reina Sofía, Córdoba, Spain.
Ann Allergy Asthma Immunol. 2009 Mar;102(3):247-52. doi: 10.1016/S1081-1206(10)60088-9.
Subcutaneous immunotherapy is an etiological therapy for certain IgE-mediated diseases. It is usually administered in 2 phases: induction and maintenance. Administration in clustered schedules during the induction phase may be a valid alternative to reach the maintenance dose early if the treatment is well tolerated.
To compare the tolerability of different clustered schedules in subcutaneous immunotherapy with standardized allergen extracts administered and to identify factors associated with increased risk of systemic reactions (SRs).
Retrospective, observational, multicenter study in patients with allergic respiratory disease.
Data from 1,147 patients were collected. Thirty-nine patients (3.4%) experienced 42 SRs (0.6% of doses). According to the European Academy of Allergy and Clinical Immunology SR grading system, there were 7 grade 0 reactions (16.7%), 26 grade 1 reactions (61.9%), 8 grade 2 reactions (19.0%), and 1 grade 3 reaction (2.4%). There were no grade 4 SRs (anaphylactic shock). We observed a higher risk of SRs in patients who received an initial dose higher than 0.3 index of reactivity (IR); only 2 reactions occurred after administration of the initial dose of the regimen, both with 0.4 IR. The remainder appeared in subsequent injections, although never with a dose lower than 0.35 IR.
Clustered regimens with IR-standardized extracts are an alternative to classic immunotherapy thanks to their low incidence of SRs compared with other rapid regimens during the induction phase. The ideal clustered regimen should start at an initial dose no greater than 0.35 IR to minimize the incidence of SRs.
皮下免疫疗法是某些IgE介导疾病的病因疗法。通常分两个阶段进行：诱导期和维持期。如果治疗耐受性良好，在诱导期采用集中给药方案可能是提前达到维持剂量的有效替代方法。
比较皮下免疫疗法中不同集中给药方案使用标准化变应原提取物时的耐受性，并确定与全身反应（SRs）风险增加相关的因素。
对过敏性呼吸道疾病患者进行回顾性、观察性、多中心研究。
收集了1147例患者的数据。39例患者（3.4%）发生了42次全身反应（占剂量的0.6%）。根据欧洲变态反应和临床免疫学会的全身反应分级系统，有7次0级反应（16.7%），26次1级反应（61.9%），8次2级反应（19.0%），1次3级反应（2.4%）。没有4级全身反应（过敏性休克）。我们观察到，初始剂量高于0.3反应性指数（IR）的患者发生全身反应的风险更高；在方案初始剂量给药后仅发生了2次反应，均为0.4 IR。其余反应出现在后续注射中，尽管剂量从未低于0.35 IR。
与诱导期的其他快速给药方案相比，采用IR标准化提取物的集中给药方案是经典免疫疗法的一种替代方法，因为其全身反应发生率较低。理想的集中给药方案应从初始剂量不超过0.35 IR开始，以尽量减少全身反应的发生率。
