Department of Medicine, Division of Clinical Allergy and Immunology, University of Mississippi Medical Center, Jackson, USA.
Ann Allergy Asthma Immunol. 2011 Nov;107(5):432-6. doi: 10.1016/j.anai.2011.05.021. Epub 2011 Jun 15.
Allergic fungal sinusitis is a disease for which optimal treatment is unclear. Previous studies using fungal immunotherapy reported less recurrence after surgery. There has been concern that traditional high-dose immunotherapy could induce systemic hypersensitivity in patients with this condition.
To determine the safety of high-dose subcutaneous fungal immunotherapy in patients with allergic fungal sinusitis.
Safety of high-dose subcutaneous fungal immunotherapy was assessed in 14 patients from our clinic who met diagnostic criteria for allergic fungal sinusitis. Results were compared to a control group of 14 patients with chronic rhinosinusitis without allergic fungal sinusitis who received subcutaneous fungal immunotherapy. We also performed a literature search to identify all previous reports of subcutaneous fungal immunotherapy.
No differences between numbers of immediate local or large local reactions, delayed local reactions, or required dose adjustments were noted between patient and control groups. One patient from each group experienced a mild systemic urticarial reaction to immunotherapy. Similarly, there were no differences in complications in either group that also received immunotherapy with nonfungal allergens. No patient developed evidence of immune complex disease. Eight publications were identified for inclusion in our literature analysis, 7 of which used low-dose subcutaneous immunotherapy. None of these noted complications more serious than local reactions.
Our data demonstrate that subcutaneous fungal immunotherapy in patients with allergic fungal sinusitis is unlikely to cause adverse reactions other than those occurring with pollen immunotherapy. Clinical trials of high-dose, traditional immunotherapy with fungal allergens for efficacy may proceed in patients with allergic fungal sinusitis without undue concern.
变应性真菌性鼻旁窦炎的最佳治疗方法尚不清楚。既往使用真菌免疫疗法的研究报告称，手术后复发率较低。人们担心，传统的高剂量免疫疗法可能会使患有这种疾病的患者产生全身过敏反应。
确定高剂量皮下真菌免疫疗法在变应性真菌性鼻旁窦炎患者中的安全性。
评估了我们诊所中 14 名符合变应性真菌性鼻旁窦炎诊断标准的患者接受高剂量皮下真菌免疫疗法的安全性。将结果与 14 名患有慢性鼻旁窦炎而无变应性真菌性鼻旁窦炎且接受皮下真菌免疫疗法的对照组进行比较。我们还进行了文献检索，以确定所有以前关于皮下真菌免疫疗法的报告。
在患者组和对照组之间，局部即刻或大局部反应、局部延迟反应或需要剂量调整的数量没有差异。两组各有 1 例患者对免疫疗法有轻度全身性荨麻疹反应。同样，两组患者也接受了非真菌变应原的免疫治疗，在并发症方面也没有差异。没有患者出现免疫复合物病的证据。有 8 篇文献被纳入我们的文献分析，其中 7 篇使用了低剂量皮下免疫疗法。这些研究均未报道比局部反应更严重的并发症。
我们的数据表明，皮下真菌免疫疗法在变应性真菌性鼻旁窦炎患者中不太可能引起除花粉免疫疗法以外的不良反应。对于患有变应性真菌性鼻旁窦炎的患者，进行高剂量、传统真菌变应原免疫治疗疗效的临床试验可能不会引起过度担忧。
