经皮下特异性免疫治疗的支气管哮喘和/或过敏性鼻炎患儿全身不良反应观察及危险因素分析

Systemic reactions to subcutaneous immunotherapy for bronchial asthma and/or allergic rhinitis in children and their risk factors

摘要:

目的 分析皮下特异性免疫治疗（SCIT）治疗儿童支气管哮喘和/或变应性鼻炎的全身不良反应（SR）的发生情况及危险因素。方法 回顾性分析该院儿科收治的支气管哮喘和/或变应性鼻炎患儿198例为研究对象。根据所有患儿SCIT过程中SR和局部不良反应（LR）的发生情况，分为SR组（n=31）及对照组（未发生SR及LR的患儿，n=142），采用logistic多因素回归分析对发生SR的危险因素进行分析。结果 在对198例患儿的8 157次SCIT注射中，共有25（12.6%）例患儿发生31例次（0.38%）SR，其中Ⅰ级SR 18例次（58%），Ⅱ级SR 10例次（32%），Ⅲ级SR 3例次（10%），无Ⅳ级SR。多因素logistic回归分析显示同时合并食物及吸入过敏原的多重过敏、尘螨sIgE 6级、总IgE 6级、既往LR发生史是SR的独立危险因素（P < 0.05）。结论 SCIT治疗哮喘和/或过敏性鼻炎的SR发生率低，安全性良好。对同时合并食物及吸入过敏原的多重过敏、高敏状态（尘螨sIgE 6级、总IgE 6级）、既往局部不良反应发生史者需警惕SR发生。

Abstract:

Objective To investigate the incidence of systemic reactions (SR) to subcutaneous immunotherapy (SCIT) for bronchial asthma and/or allergic rhinitis in children and their risk factors. Methods A retrospective analysis was performed on 198 children with bronchial and/or allergic rhinitis. According to the presence or absence of SR and local reactions (LR) during SCIT, the patients were divided into two groups:SR (with SR and LR, n=31) and control (without SR or LR, n=142). A multivariate logistic regression analysis was used to determine the risk factors associated with SR. Results Among the 198 patients who received 8 157 injections of SCIT, 25 (12.6%) experienced SR (31 times, 0.38%), including grade I SR (18 times, 58%), grade II SR (10 times, 32%), grade III SR (3 times, 10%), and no grade IV SR. The multivariate logistic regression analysis showed that multiple sensitization with both food and inhaled allergens, specific IgE to dust mites (grade 6), total IgE (grade 6), and a history of LR were independent risk factors for SR (P < 0.05). Conclusions SCIT is a safe treatment for bronchial asthma and/or allergic rhinitis in children, with a low incidence of SR. Children with multiple sensitization with both food and inhaled allergens, a hypersensitive state (specific IgE to dust mites, grade 6; total IgE, grade 6), and a history of LR have an increased risk of SR to SCIT.