Walker S M, Varney V A, Gaga M, Jacobson M R, Durham S R
Allergy Clinic, Royal Brompton Hospital, London, UK.
Allergy. 1995 May;50(5):405-13. doi: 10.1111/j.1398-9995.1995.tb01170.x.
Grass pollen immunotherapy is effective, although efficacy must be balanced against side-effects. In a double-blind, placebo-controlled trial of 40 adult patients with summer hay fever, immunotherapy with a depot grass pollen extract (Phleum pratense, Alutard SQ) reduced symptoms and medication requirements with an acceptable minimal level of side-effects (31). The original placebo group, as well as the actively treated group, have now received active immunotherapy in an open fashion for a further 3 years. An important question was whether continued injection treatment was accompanied by maintained clinical improvement. By analysis of diary symptoms, rescue medication, and visual analogue scores during the pollen season, we show that efficacy was maintained throughout the 3-4-year study period. Clinical improvement was accompanied by a sustained and marked decrease in immediate conjunctival allergen sensitivity and a further significant decrease in the size of the allergen-induced late cutaneous response. In contrast, an initial decrease in the allergen-induced immediate cutaneous response was not maintained at 3-4 years. Of the patients, 37/40 completed the first year, 33/40 the second year, and 32/40 the third year of treatment. Patients dropped out for reasons other than the outcome of immunotherapy. During a total of 2598 injections, five immediate systemic reactions were observed, all during the induction (not maintenance) phase, and all occurred within 10 min of injection and responded promptly to adrenaline. Grass pollen immunotherapy is effective and safe, provided it is performed on carefully selected patients by trained physicians with immediate access to resuscitative measures.
草花粉免疫疗法是有效的，不过疗效必须与副作用相权衡。在一项针对40名成年夏季花粉症患者的双盲、安慰剂对照试验中，使用长效草花粉提取物（早熟禾，阿卢塔德SQ）进行免疫疗法减轻了症状并减少了药物需求，且副作用处于可接受的最低水平（31）。原来的安慰剂组以及积极治疗组，现在又以开放方式接受了3年的主动免疫疗法。一个重要的问题是持续注射治疗是否伴随着持续的临床改善。通过分析花粉季节期间的日记症状、急救药物使用情况和视觉模拟评分，我们发现疗效在整个3至4年的研究期间得以维持。临床改善伴随着即刻结膜过敏原敏感性的持续显著下降以及过敏原诱发的迟发性皮肤反应大小的进一步显著下降。相比之下，过敏原诱发的即刻皮肤反应在3至4年时并未维持最初的下降。40名患者中，37名完成了第一年治疗，33名完成了第二年治疗，32名完成了第三年治疗。患者退出并非因为免疫疗法的结果。在总共2598次注射过程中，观察到5次即刻全身反应，均发生在诱导（而非维持）阶段，且均在注射后10分钟内出现，并对肾上腺素迅速产生反应。草花粉免疫疗法是有效且安全的，前提是由训练有素的医生对精心挑选的患者进行治疗，并能立即采取复苏措施。
