Asero R
Ambulatorio di Allergologia, Clinica San Carlo, Via Ospedale 21 20037, Paderno Dugnano (MI), Italy. Phone: +39 02 990 38 470 Fax: +39 02 990 38 223 E-mail:
Eur Ann Allergy Clin Immunol. 2015 Nov;47(6):211-7.
Some patients seem to show a particular propensity to experience systemic reactions (SR) when undergoing SCIT. This study looked at their features.
423 adults submitted to subcutaneous immunotherapy (SCIT) with 583 depot allergens extracts were studied. A "slow" build-up schedule was followed, and maintenance doses were given monthly. No mixtures of allergens were employed; multi-sensitized patients were treated with two extracts at the same time. IgE to pollen allergen components were measured. Patients experiencing several SR and those showing repeated large local reactions preventing up dosing were analyzed.
Altogether, 14% of patients experienced at least 2 SR to SCIT and further 13% repeated local reactions. All SR involved the skin. Eight treatments were stopped. No reactor was using beta-blockers. SR were not associated with pollen season, use of freshly prepared vials, administration of 2 allergens, or extract producer, nor were preceded by large local reactions. Reactors were younger than tolerant subjects (p<0.05), and females were less frequently fully tolerant than males (p<0.001). The multiple regression analysis showed that both ragweed and grass SCIT were significantly associated with adverse reactions (p<0.001). Specific IgE to Amb a 1 or Phl p 1 did not differ statistically between reactors and tolerant subjects, whereas grass pollen-allergic reactors showed higher levels of IgE to Phl p 5. Intolerance did not depend on the number of primary sensitizations or on hypersensitivity to pollen pan-allergens.
Young patients or women hypersensitive to grass and ragweed pollen seem at higher risk for SR during SCIT.
一些患者在接受皮下免疫治疗（SCIT）时似乎特别容易出现全身反应（SR）。本研究观察了他们的特征。
对423名接受583种长效变应原提取物皮下免疫治疗（SCIT）的成年人进行了研究。采用“缓慢”递增方案，每月给予维持剂量。未使用变应原混合物；对多种致敏患者同时使用两种提取物进行治疗。检测了对花粉变应原成分的IgE。对经历多次SR的患者以及出现反复严重局部反应而无法增加剂量的患者进行了分析。
总共14%的患者在SCIT时经历了至少2次SR，另有13%出现反复局部反应。所有SR均累及皮肤。8次治疗中断。没有反应者使用β受体阻滞剂。SR与花粉季节、使用新制备的药瓶、给予2种变应原或提取物生产商无关，也不是由严重局部反应引起的。反应者比耐受者年轻（p<0.05），女性完全耐受的频率低于男性（p<0.001）。多元回归分析表明，豚草和禾本科植物的SCIT均与不良反应显著相关（p<0.001）。反应者和耐受者之间针对Amb a 1或Phl p 1的特异性IgE在统计学上无差异，而对禾本科花粉过敏的反应者针对Phl p 5的IgE水平较高。不耐受并不取决于初次致敏的数量或对花粉泛变应原的超敏反应。
对豚草和禾本科花粉过敏的年轻患者或女性在SCIT期间发生SR的风险似乎更高。
