Rondon Cinthya, Sánchez-Borges Mario, Cupello Eliana Risquez, Fabiano Fabiola, Capriles-Hulett Arnaldo
Hospital San Juan de Dios, Allergology Unit, Caracas, Venezuela.
Centro Medico Docente La Trinidad, Caracas, Venezuela.
Allergol Immunopathol (Madr). 2021 Mar 1;49(2):31-39. doi: 10.15586/aei.v49i2.52. eCollection 2021.
Aqueous allergen injections, an effective and century-old technique, is considered a second-line approach in daily clinical practice. Inconveniences still surround conventional subcutaneous immunotherapy (SCIT) administration, such as a need for frequent injections, prolonged up-dosing schedules, elevated costs, and the unlikely possibility of a systemic reaction. The intradermal immunotherapy route (IDR) might favorably impact many of the aforementioned issues (Table 1). House dust mite (HDM) allergens are the main perennial sensitizers in the tropics, and as such, are solely employed in immunotherapy treatments.
We carried out a year-long real-life study in 25 perennial allergic rhinitis children, symptomatic on exposure to house dust, employing an intradermal low-dose allergen mix consisting of 50 ng of Dermatophagoides pteronyssinus/Dermatophagoides farinae and 120 ng of Blomia tropicalis, under a unique cost-wise protocol. Basal symptoms/signs and face Visual Analog Scale (fVAS) scores were recorded for 2 weeks and later compared with those registered throughout the 1-year treatment. Serum-specific IgG4 and IL-10 levels were employed in the assessment of the immune responses.
Symptoms/signs and fVAS scores were significantly reduced from days 42 and 49, respectively, and remained so until treatment completion. Increases in specific IgG4's and IL-10 levels reflected significant immune responses. Injections were well tolerated and families reported improved health status (quality of life, QoL).
A unique cost-effective immunotherapy alternative for deprived allergic communities in tropical settings is depicted; further research is needed.
变应原水针注射是一项行之有效的百年技术，在日常临床实践中被视为二线治疗方法。传统皮下免疫疗法（SCIT）仍存在诸多不便之处，比如需要频繁注射、递增给药方案耗时较长、费用高昂，以及发生全身反应的可能性不大。皮内免疫疗法途径（IDR）可能会对上述诸多问题产生有利影响（表1）。屋尘螨（HDM）变应原是热带地区主要的常年性致敏原，因此仅用于免疫治疗。
我们对25名常年性变应性鼻炎儿童进行了为期一年的实际研究，这些儿童在接触屋尘后出现症状，采用一种皮内低剂量变应原混合制剂，其中包含50纳克的粉尘螨/屋尘螨和120纳克的热带无爪螨，遵循一种独特的成本效益方案。记录基础症状/体征和面部视觉模拟量表（fVAS）评分，为期2周，之后与整个1年治疗期间记录的评分进行比较。采用血清特异性IgG4和IL-10水平评估免疫反应。
症状/体征和fVAS评分分别从第42天和第49天开始显著降低，并一直保持到治疗结束。特异性IgG4和IL-10水平的升高反映了显著的免疫反应。注射耐受性良好，患儿家庭报告健康状况（生活质量，QoL）有所改善。
描述了一种适用于热带地区贫困变应性群体的独特的经济有效的免疫治疗替代方法；还需要进一步研究。
