Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel.
Ann Allergy Asthma Immunol. 2010 Jan;104(1):73-8. doi: 10.1016/j.anai.2009.11.001.
An anaphylactic reaction is one of the alarming adverse effects of allergen immunotherapy. Although a systemic reaction can follow a biphasic course, its incidence, its outcome, and the risk factors for its development are unknown in patients treated with immunotherapy.
To record the incidence, characteristics, and outcome of immunotherapy-inflicted biphasic reactions (BRs).
All patients attending large in-hospital allergy clinics for immunotherapy were followed up prospectively. Recorded patient data included the following: demographics, diagnosis, type and phase of immunotherapy, and peak expiratory flow (PEF) before each administration of the injections. If an anaphylactic reaction occurred, medical treatment was recorded and the patient was asked to complete a 3-day diary that included symptoms and periodic measurements of PEF. A BR was defined as a late decrease in PEF of more than 20%, with or without accompanying symptoms.
During 10,040 visits, 453 patients received 21,022 immunotherapy injections and 131 anaphylactic reactions occurred. Of these reactions, 11 (10%) were biphasic. Most uniphasic reactions (URs) and all BRs occurred in patients who were being treated for allergic rhinitis. A low baseline PEF or concomitant asthma was more common in patients with BRs. Other parameters were comparable between patients with URs and BRs. All BRs were mild and resolved either spontaneously or with oral antihistamines.
Immunotherapy-induced BRs are uncommon. They tend to be mild and might be more common in patients with a low baseline PEF or concomitant asthma. Therefore, a long observation after the initial reaction is not required.
过敏免疫治疗会引起过敏反应，这是一种严重的不良反应。尽管全身过敏反应可能具有双相过程，但目前尚不清楚接受免疫治疗的患者中双相反应的发生率、结局和发展风险因素。
记录免疫治疗引起的双相反应（BR）的发生率、特征和结局。
前瞻性随访所有在大型院内过敏诊所接受免疫治疗的患者。记录的患者数据包括：人口统计学、诊断、免疫治疗类型和阶段以及每次注射前的呼气峰流速（PEF）。如果发生过敏反应，记录治疗方法，并要求患者完成为期 3 天的日记，记录症状和定期测量 PEF。BR 定义为 PEF 较基线下降超过 20%，伴有或不伴有伴随症状。
在 10040 次就诊中，453 名患者接受了 21022 次免疫治疗注射，发生了 131 次过敏反应。其中 11 次（10%）为双相反应。大多数单相反应（UR）和所有 BR 均发生在正在接受过敏性鼻炎治疗的患者中。BR 患者的基础 PEF 较低或合并哮喘更为常见。BR 患者与 UR 患者的其他参数无差异。所有 BR 均为轻度，且均自行缓解或用口服抗组胺药缓解。
免疫治疗引起的 BR 并不常见。它们往往是轻度的，在基础 PEF 较低或合并哮喘的患者中可能更为常见。因此，无需对初始反应后进行长时间观察。
