Portnoy J, Bagstad K, Kanarek H, Pacheco F, Hall B, Barnes C
Section of Allergy/Immunology, Children's Mercy Hospital, Kansas City, Missouri.
Ann Allergy. 1994 Nov;73(5):409-18.
Rush immunotherapy, while having many potential benefits, is associated with an increased incidence of systemic reactions.
To determine whether pretreatment with medications reduces the rate of systemic reactions during rush immunotherapy and to identify predictors of such reactions if possible.
We conducted a double-blind, placebo-controlled study of 22 allergic children ages 6 to 18 years who received rush immunotherapy. Active treatment consisted of a combination of H1 and H2 histamine antagonists and a corticosteroid in gelatin capsules given prior to administration of rush immunotherapy whereas placebo patients received lactose. Rush immunotherapy consisted of eight injections of increasing doses of a mixture of allergens to which each patient was skin-reactive over 1 1/2 days. Serial skin tests and peak expiratory flow rate measurements were performed during the procedure. Following the initial series of injections, patients were followed for 8 weeks and had blood drawn at 2-week intervals for measurements of specific IgG and IgE.
Systemic reactions were observed in 3 (27%) active and 8 (73%) placebo patients (Fisher's exact test: P = .047). The mean time for systemic reactions was 63 minutes after a previous injection. The most common dose causing a systemic reaction was 0.3 mL of 1:1000 (wt/vol). The best predictors of development of a systemic reaction were degrees of skin sensitivity to the extract before and after premedication. Local reactions were not associated with subsequent systemic reactions. Specific IgG rose by 2 weeks while specific IgE did not change significantly during the 8-week follow-up period. Pretreatment did not change the number of systemic reactions seen with subsequent injections.
Premedication significantly reduces the incidence of systemic reactions during rush immunotherapy and is therefore recommended. Degree of skin sensitivity to the injected extract may eventually prove to be a clinically useful predictor for the development of systemic reactions.
快速免疫疗法虽有诸多潜在益处，但与全身反应发生率增加相关。
确定药物预处理是否能降低快速免疫疗法期间全身反应的发生率，并尽可能识别此类反应的预测因素。
我们对22名6至18岁接受快速免疫疗法的过敏儿童进行了一项双盲、安慰剂对照研究。积极治疗包括在快速免疫疗法给药前给予H1和H2组胺拮抗剂及皮质类固醇的明胶胶囊组合，而安慰剂组患者接受乳糖。快速免疫疗法包括在1.5天内分八次注射剂量递增的患者皮肤反应性过敏原混合物。在此过程中进行系列皮肤试验和呼气峰值流速测量。在最初一系列注射后，对患者随访8周，并每2周采血一次以测量特异性IgG和IgE。
3名（27%）积极治疗患者和8名（73%）安慰剂患者出现全身反应（Fisher精确检验：P = 0.047）。全身反应的平均时间是在上一次注射后63分钟。引起全身反应的最常见剂量是1:1000（重量/体积）的0.3 mL。全身反应发生的最佳预测因素是用药前和用药后对提取物的皮肤敏感程度。局部反应与随后的全身反应无关。特异性IgG在2周时升高，而特异性IgE在8周随访期内无显著变化。预处理并未改变后续注射时出现的全身反应数量。
预处理可显著降低快速免疫疗法期间全身反应的发生率，因此推荐使用。对注射提取物的皮肤敏感程度最终可能被证明是全身反应发生的临床有用预测因素。
