Bahceci Erdem Semiha, Nacaroglu Hikmet Tekin, Karaman Sait, Unsal Karkıner Canan Sule, Gunay Ilker, Dogan Done, Asilsoy Suna, Altınoz Serdar, Can Demet
Department of Pediatric Allergy, Dr Behcet Uz Children's Hospital, Izmir, Turkey.
Department of Pediatric Allergy, Dr Behcet Uz Children's Hospital, Izmir, Turkey.
Int J Pediatr Otorhinolaryngol. 2016 May;84:55-60. doi: 10.1016/j.ijporl.2016.02.032. Epub 2016 Mar 5.
Even though allergen immunotherapy is an effective treatment method that has been used on rhinitis, asthma and venom anaphylaxis for over 100 years, systemic reactions (SRs) limit the use of this treatment method. We classified SRs associated with subcutaneous immunotherapy (SCIT) according to the World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. Risk factors for the SRs were assessed.
In this study 67,758 injections to 1350 children with allergic rhinitis and/or asthma were analyzed throughout January 1999-December 2014.
A total of 51 systemic reactions were observed in 39 patients (0.075% per injection, %3 per patient). Mean age of SRs observed patients was 13±2.6 years (range 9.5-16 years) and 64.1% were male, 35.9% were female. 51.3% of SRs were grade 1, 38.5% grade 2, 7.7% grade 3 and 2.6% grade 4. SRs were early onset in 41% of the patients and delayed onset in 59%. 76.9% of SRs were seen during maintenance therapy and 56.4% during peak pollen season. In 28.2% of cases previous local reactions and in 30.8% previous grade 1 reactions were determined. There was no fatal outcome from any of the SRs.
SCIT related SRs are generally of mild severity. Although only 10% of the SRs were grade 3 or 4, there is a still a small risk of severe reactions. 76.9% of SRs were observed during maintenance therapy. Delayed-onset SRs rate in our study is 59%. So both clinicians and parents should be alert about the delayed reactions after SCIT.
尽管变应原免疫疗法是一种已在鼻炎、哮喘和毒液过敏反应治疗中使用超过100年的有效治疗方法，但全身反应限制了该治疗方法的应用。我们根据世界变态反应组织皮下免疫疗法全身反应分级系统对与皮下免疫疗法（SCIT）相关的全身反应进行分类。评估全身反应的危险因素。
本研究分析了1999年1月至2014年12月期间对1350例过敏性鼻炎和/或哮喘儿童进行的67758次注射。
共观察到39例患者发生51次全身反应（每次注射0.075%，每位患者3%）。发生全身反应的患者平均年龄为13±2.6岁（范围9.5 - 16岁），男性占64.1%，女性占35.9%。51.3%的全身反应为1级，38.5%为2级，7.7%为3级，2.6%为4级。41%的患者全身反应为速发，59%为迟发。76.9%的全身反应发生在维持治疗期间，56.4%发生在花粉高峰季节。28.2%的病例有既往局部反应，30.8%有既往1级反应。所有全身反应均无致命后果。
与SCIT相关的全身反应一般严重程度较轻。虽然只有10%的全身反应为3级或4级，但仍有发生严重反应的小风险。76.9%的全身反应发生在维持治疗期间。我们研究中迟发全身反应的发生率为59%。因此，临床医生和家长都应警惕SCIT后的迟发反应。
