Mississippi Asthma and Allergy Clinic, Jackson, Mississippi 39110, USA.
Allergy Asthma Proc. 2011 Jul-Aug;32(4):288-94. doi: 10.2500/aap.2011.32.3446.
The use of epinephrine for anaphylaxis to subcutaneous allergen immunotherapy (SCIT) is the standard of care, but its use for mild systemic reactions (SRs) is somewhat controversial. The objective of this study is to determine the rate of SR to SCIT, the symptoms reported, and the response to intramuscular (i.m.) epinephrine over a 1 year period. This retrospective study was designed to evaluate SRs to SCIT to any combination of approximately 20 allergens (pollens, animal emanations, molds, and Hymenoptera) in 773 subjects representing 14,707 visits, receiving approximately 28,000 injections over 1 year. Nurses were instructed to administer epinephrine (1:1000 v/v) 0.2 mL i.m. for signs or symptoms of a SR. SRs were graded using the universal grading system proposed by the World Allergy Organization (WAO) Joint Task Force for Grading SR to Immunotherapy. Thirty-one patients (4%) had 32 SRs, 22 (71%) female, average age 40 yr. Nineteen (61%) had a history of asthma; 7 (22.6%) had a history of a previous SR. SRs were reported on average 24 minutes after injection. Symptoms included: generalized pruritus, 34.4%; upper airway pruritus, 28.1%; cough, 25.0%; shortness of breath, 21.9%. Fourteen SRs were classified as Grade 1, thirteen Grade 2, two Grade 3, and three Grade 4. No Grade 5 or late phase reactions were reported. 29 (90.6%) reactions were treated with epinephrine, 27 (84.4%) glucocorticosteroid, and 30 (93.8%) H1 antihistamine. SRs occurred in 4% of patients receiving SCIT and all who received early intervention with epinephrine responded successfully. The WAO Grading system was useful.
皮下变应原免疫治疗（SCIT）中肾上腺素的使用是标准的治疗方法，但在轻度全身反应（SRs）中的使用有些争议。本研究的目的是确定 SCIT 中 SR 的发生率、报告的症状以及在 1 年内对肌肉内（i.m.）肾上腺素的反应。这项回顾性研究旨在评估 773 名患者在 14707 次就诊中接受大约 20 种过敏原（花粉、动物分泌物、霉菌和膜翅目昆虫）的任何组合的 SCIT 时发生的 SR 率、报告的症状以及对 i.m.肾上腺素的反应。护士被指示在出现 SR 症状或体征时给予肾上腺素（1:1000 v/v）0.2 mL i.m.。SR 使用世界过敏组织（WAO）免疫治疗分级联合工作组提出的通用分级系统进行分级。31 名患者（4%）出现 32 次 SR，22 名（71%）为女性，平均年龄为 40 岁。19 名（61%）有哮喘病史；7 名（22.6%）有先前 SR 病史。SR 在注射后平均 24 分钟报告。症状包括：全身性瘙痒，34.4%；上呼吸道瘙痒，28.1%；咳嗽，25.0%；呼吸急促，21.9%。14 次 SR 被归类为 1 级，13 次 2 级，2 次 3 级，3 次 4 级。没有报告 5 级或迟发性反应。29 次（90.6%）反应用肾上腺素治疗，27 次（84.4%）用糖皮质激素治疗，30 次（93.8%）用 H1 抗组胺药治疗。在接受 SCIT 的患者中，有 4%发生了 SR，所有接受早期肾上腺素干预的患者均成功应答。WAO 分级系统很有用。
