渐进延长维持治疗间隔的变应原免疫治疗的安全性和疗效。
Safety and Efficacy of a Progressively Prolonged Maintenance Interval of Venom Immunotherapy.
机构信息
Allergology Department, Laikon General Hospital, Athens, Greece.
Department of Allergology, Euroclinic Hospital of Athens, Athens, Greece.
出版信息
Int Arch Allergy Immunol. 2018;176(1):39-43. doi: 10.1159/000488143. Epub 2018 Apr 12.
BACKGROUND
The long-term protection provided by venom immunotherapy (VIT) is related to the dose administered and to its long duration; the latter, however, becomes inconvenient for patients in countries like Greece, with many islanders or inhabitants of distant mountainous areas. Maintenance interval prolongation reduces the number of office visits - saving time and money - and as a consequence contributes to the patients' compliance. The aim of this prospective study was to evaluate the safety and efficacy of VIT on a progressively prolonged maintenance interval (PPMI).
METHOD
450 venom-allergic patients were reviewed for participation in our study; all of them were initially treated with a modified rush or an ultrarush protocol using freshly reconstituted, pure venoms. Upon reaching the maintenance dose, the VIT interval was scheduled to be gradually prolonged - by 1 week each time - aiming at a maximal interval of 26 weeks.
RESULTS
267/450 patients consented to participate in our VIT PPMI protocol: 98 were treated with vespid(s) venom, 142 with honeybee venom, and 27 with both. The mean duration of patient follow-up was 9.1 ± 4.2 years. The majority of systemic reactions due to VIT injections occurred up to the 8-weeks PPMI; few additional reactions were documented in a small fraction (2.9%) of our patient population beyond 9 weeks and up to 16 weeks; all were caused by honeybee VIT. No reactions were observed during VIT administration at the 26-week interval. Ninety-six patients reported 204 field sting occurrences by the culprit insect. Ten systemic reactions (8 mild and 2 moderate in severity) were registered between the 9- and 18-week PPMI; the honeybee was the culprit insect in all cases. 108 field stings by the offending insect were sustained beyond the 20- and up to the 26-week PPMI; there were no reactions at all.
CONCLUSIONS
Progressively prolonging the VIT maintenance interval up to 26 weeks appears to be safe and efficacious.
背景
毒液免疫疗法（VIT）的长期保护与给予的剂量及其长期持续时间有关；然而，对于像希腊这样的国家的患者来说，后者变得不方便，因为该国许多岛屿居民或居住在偏远山区。延长维持间隔可减少就诊次数——节省时间和金钱——并因此有助于提高患者的依从性。本前瞻性研究的目的是评估在逐渐延长维持间隔（PPMI）的情况下 VIT 的安全性和有效性。
方法
对 450 名过敏毒液的患者进行了参加我们研究的审查；他们最初都使用经过改良的冲击或超速冲击方案，使用新鲜配制的纯毒液进行治疗。达到维持剂量后，VIT 间隔时间计划逐渐延长——每次延长 1 周——目标是最长间隔 26 周。
结果
267/450 名患者同意参加我们的 VIT PPMI 方案：98 名患者接受蜂（蜂）毒液治疗，142 名患者接受蜜蜂毒液治疗，27 名患者同时接受两种毒液治疗。患者随访的平均时间为 9.1±4.2 年。大多数由于 VIT 注射引起的全身性反应发生在 PPMI 的 8 周内；在我们患者人群中的一小部分（2.9%）中，在 9 周后和长达 16 周内记录到了更多的额外反应；所有这些反应都是由蜜蜂 VIT 引起的。在 26 周间隔的 VIT 给药期间未观察到反应。96 名患者报告了 204 次由罪魁祸首昆虫引起的野外蜇伤。在 PPMI 的 9-18 周之间，有 10 例全身反应（8 例轻度，2 例中度），所有这些反应都是由蜜蜂引起的。在 PPMI 的 20-26 周之间，有 108 次由致伤昆虫引起的野外蜇伤，没有任何反应。
结论
逐渐将 VIT 维持间隔延长至 26 周似乎是安全有效的。
Zotero 插件