免疫治疗致死和非致死反应的风险因素（2008-2018 年）：注射后监测和严重哮喘。
Risk factors for fatal and nonfatal reactions to immunotherapy (2008-2018): postinjection monitoring and severe asthma.
机构信息
Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; Allergy Partners of Central Indiana, Indianapolis, Indiana.
Bernstein Clinical Research Center, LLC, Cincinnati, Ohio.
出版信息
Ann Allergy Asthma Immunol. 2021 Jul;127(1):64-69.e1. doi: 10.1016/j.anai.2021.03.011. Epub 2021 Mar 19.
BACKGROUND
Subcutaneous allergen immunotherapy (SCIT) is highly effective but risks exist.
OBJECTIVE
To identify practices that influence systemic allergic reactions (SRs) to SCIT and SCIT-associated infections.
METHODS
Members of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology completed an annual survey of SCIT-related SRs of varying severity (2008-2018). Injection-related infections were queried (2014-2018). Strategies to enforce postinjection waiting times and to reduce risks from asthma/severe asthma were queried (2016-2018).
RESULTS
Data were gathered on 64.5 million injection visits. Ten confirmed fatalities occurred since 2008, including 3 new fatalities since 2017. One fatal reaction occurred per 7.2 million injection visits (2008-2018). No infections occurred. Practices that tracked the time after injections, and required checking out with office personnel, had significantly lower total (P < .001), grade 3 (severe) (P < .001), and grade 4 (very severe) SRs (P < .001). Having more individuals with asthma on SCIT was associated with more grade 3 SRs (P < .02). Not prescribing SCIT in individuals with uncontrolled asthma was associated with fewer grade 3 SRs (P = .02). Having individuals with more severe asthma on SCIT was associated with more total, grade 1, and grade 2 SRs (P < .001); 50% of grade 3 and 4 SRs occurred in individuals with severe asthma.
CONCLUSION
SCIT-related fatalities have declined since 2008, with a slight increase in recent years. SCIT is not associated with an increased risk of infections. Tracking the time after injections and checking out with office staff confer significantly lower risks of severe SRs. Asthma, especially severe asthma, is a major risk factor for severe and fatal SRs. Strategies that reduce risks for individuals with asthma, such as not prescribing SCIT to patients with uncontrolled asthma, may lower the risks.
背景
皮下变应原免疫疗法（SCIT）非常有效，但存在风险。
目的
确定影响 SCIT 和 SCIT 相关感染的全身性过敏反应（SRs）的做法。
方法
美国过敏、哮喘和免疫学学院和美国过敏、哮喘和免疫学学院的成员完成了一项关于不同严重程度的 SCIT 相关 SRs 的年度调查（2008-2018 年）。询问了与注射相关的感染情况（2014-2018 年）。询问了加强注射后等待时间和降低哮喘/严重哮喘风险的策略（2016-2018 年）。
结果
自 2008 年以来，共收集了 6450 万次注射就诊的数据。自 2017 年以来，有 3 例新的死亡病例，自 2008 年以来共发生了 10 例致命反应。每 720 万次注射就诊就会发生 1 例致命反应（2008-2018 年）。未发生感染。跟踪注射后时间并要求与办公室人员核对的做法，总 SRs（P<0.001）、3 级（严重）SRs（P<0.001）和 4 级（非常严重）SRs（P<0.001）明显较低。在接受 SCIT 的哮喘患者中，更多的人发生 3 级 SRs（P<0.02）。未在未控制的哮喘患者中开具 SCIT 处方与较少的 3 级 SRs 相关（P=0.02）。在接受 SCIT 的哮喘患者中，病情越严重，总、1 级和 2 级 SRs 越多（P<0.001）；50%的 3 级和 4 级 SRs 发生在严重哮喘患者中。
结论
自 2008 年以来，与 SCIT 相关的死亡人数有所下降，近年来略有增加。SCIT 不会增加感染的风险。跟踪注射后的时间并与办公室工作人员核对可显著降低严重 SRs 的风险。哮喘，尤其是严重哮喘，是严重和致命 SRs 的主要危险因素。降低哮喘患者风险的策略，如不向未控制的哮喘患者开具 SCIT 处方，可能会降低风险。
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