Greineder D K
Harvard Community Health Plan Kenmore Center, Allergy Department, Boston, MA 02215, USA.
J Allergy Clin Immunol. 1996 Dec;98(6 Pt 3):S330-4.
The major risk of allergen immunotherapy is the development of systemic anaphylactic reactions. The reported frequency of systemic reactions after allergen immunotherapy varies from < 1% in patients receiving conventional immunotherapy to > 36% in patients receiving rush immunotherapy. Fatal and systemic reactions to allergen immunotherapy have similar characteristics. The onset of both types of reaction occurs < 30 minutes after injection in approximately 70% of patients. The most common risk factors for fatal and systemic reactions to allergen immunotherapy include a history of asthma, increasing allergen dose, high allergen sensitivity, previous systemic reaction, and injection during an active allergen season. On the basis of findings from several studies, precautions during allergen immunotherapy have been recommended. In addition, several interventions, including premedication with antihistamines or corticosteroids, measurement of peak flow before injection, and access to an antihistamine or injectable epinephrine after an allergen injection, have been suggested as measures to prevent reactions to and improve the safety of allergen immunotherapy. However, additional studies are necessary before these regimens are implemented routinely in allergen immunotherapy protocols.
变应原免疫疗法的主要风险是发生全身性过敏反应。变应原免疫疗法后全身性反应的报告发生率各不相同，接受传统免疫疗法的患者中低于1%，而接受快速免疫疗法的患者中则超过36%。变应原免疫疗法导致的致命性和全身性反应具有相似特征。约70%的患者在注射后不到30分钟内出现这两种反应。变应原免疫疗法导致致命性和全身性反应最常见的风险因素包括哮喘病史、变应原剂量增加、变应原高敏感性、既往全身性反应以及在变应原活跃季节进行注射。基于多项研究结果，已推荐变应原免疫疗法期间的预防措施。此外，还建议采取多种干预措施，包括使用抗组胺药或皮质类固醇进行预处理、注射前测量呼气峰流速以及在变应原注射后获取抗组胺药或注射用肾上腺素，作为预防变应原免疫疗法反应并提高其安全性的措施。然而，在这些方案常规应用于变应原免疫疗法方案之前，还需要进行更多研究。
