Birnbaum J, Charpin D, Vervloet D
Department of Chest Diseases and Allergy, Hôpital Sainte-Marguerite, Marseille, France.
Clin Exp Allergy. 1993 Mar;23(3):226-30. doi: 10.1111/j.1365-2222.1993.tb00886.x.
We compared 284 sting-allergic patients treated with either a 4 day (group 1), 6 hr (group 2) or 210 min (group 3) rapid venom immunotherapy (RVIT) protocol using honey bee (HB) or yellow jacket (YJ) venom at cumulative doses of 527.6 micrograms, 226.6 micrograms and 101.1 micrograms respectively. The 4 day protocol involved four times as many injections as the 210 min protocol and twice as many as the 6 hr protocol. Desensitization was conducted in a hospital providing full emergency resuscitation facilities. In group 1, 1 x 100 micrograms boosters were given on days 7, 10, 15 and 45 and, in groups 2 and 3, 2 x 50 micrograms boosters were given on day 15 and 1 x 100 micrograms on day 45. The patients in the three groups were comparable with regard to clinical characteristics and immunological reactivity determined by skin tests. All patients had large local reactions. Systemic reactions (SR) occurred in 28.2% of patients in group 1, 28.6% in group 2 and 6.9% in group 3. The mean total cumulative venom dose (s.e.m.) for occurrence of SR was 123.75 (+/- 24.2) in group 1, 183.27 (+/- 28.5) in group 2, and 36.43 (+/- 9.3) in group 3. HB led to more systemic reactions than YJ venom. The rate of SR decreased when the cumulative venom dose was reduced during RVIT. The median dose was 137.6 micrograms in group 1, 226.6 micrograms in group 2, and 21.1 micrograms in group 3. No systemic reactions were observed after the booster injections. The results of this study suggest that short RVIT protocols with low cumulative doses carry a lesser risk of SR.
我们比较了284例蜂蜇过敏患者，他们分别接受了4天（第1组）、6小时（第2组）或210分钟（第3组）的快速毒液免疫疗法（RVIT）方案，使用的是蜜蜂（HB）或黄蜂（YJ）毒液，累积剂量分别为527.6微克、226.6微克和101.1微克。4天方案的注射次数是210分钟方案的四倍，是6小时方案的两倍。脱敏治疗在一家具备全面紧急复苏设施的医院进行。在第1组中，在第7天、第10天、第15天和第45天给予1×100微克的加强注射，在第2组和第3组中，在第15天给予2×50微克的加强注射，在第45天给予1×100微克的加强注射。三组患者在临床特征和通过皮肤试验测定的免疫反应性方面具有可比性。所有患者均出现严重局部反应。全身反应（SR）在第1组患者中的发生率为28.2%，在第2组为28.6%，在第3组为6.9%。发生全身反应时的平均总累积毒液剂量（标准误）在第1组为123.75（±24.2），在第2组为183.27（±28.5），在第3组为36.43（±9.3）。与黄蜂毒液相比，蜜蜂毒液导致更多的全身反应。在RVIT期间降低累积毒液剂量时，全身反应的发生率降低。第1组的中位剂量为137.6微克，第2组为226.6微克，第3组为21.1微克。加强注射后未观察到全身反应。本研究结果表明，累积剂量低的短RVIT方案发生全身反应的风险较小。
