Analysis of the long-term efficacy and safety of subcutaneous immunotherapy for atopic dermatitis
Analysis of the long-term efficacy and safety of subcutaneous immunotherapy for atopic dermatitis
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DOI：
10.2500/aap.2021.42.200126
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发表时间：
2021-03-01
影响因子：
2.8
通讯作者：
Song, Zhiqiang
中科院分区：
文献类型：
--
作者：
Zhou, Jie;Chen, Shuguang;Song, Zhiqiang
介绍：特应性皮炎（AD）是一种以严重瘙痒和湿疹性皮损为特征的慢性复发性炎症性皮肤病。皮下免疫疗法（SCIT）是指反复接触逐渐增加剂量的过敏原提取物，其提高患者对此类过敏原和对照的耐受性，或减少过敏症状。本研究旨在探讨SCIT治疗屋尘螨（HDM）致敏的AD患者的长期疗效和安全性。在这些患者中，164例接受SCIT+药物治疗3年（SCIT组），另214例仅接受药物治疗（非SCIT组）。结果：SCIT组的特应性皮炎评分（SCORAD）和瘙痒视觉模拟评分（VAS）评分均显著降低，实验室检查结果和不良反应均记录在案。此外，在治疗开始后3年，SCIT组的SCORAD和瘙痒VAS评分降低率高于非SCIT组。非SCIT组发生新致敏的风险高于SCIT组（相对风险1.92 [95%置信区间{CI}，1.30-2.85]; p < 0.05）。参与者的嗜酸性粒细胞计数在完全缓解（CR）组中有显著差异（p < 0.05），但在非CR组中无显著差异（p = 0.098）。然而，血清总免疫球蛋白E值未显著降低（p = 0.204）。在给予患者的8421次注射中，231次注射（2.74%）在治疗期间显示出不良反应。结论：三年的SCIT可以显著降低HDM致敏的中重度AD的严重程度和瘙痒。多敏患者也可以从HDM SCIT中获益。患者可以获得长期效果，如预防新过敏原致敏和抑制过敏进程。
Introduction: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease characterized by severe pruritus and eczematous skin lesions. Subcutaneous immunotherapy (SCIT) refers to repeated contact with gradually increasing doses of allergen extracts, which improve patient tolerance to such allergens and controls, or reduces allergic symptoms. This study aimed to explore the long-term efficacy and safety of SCIT for patients with AD sensitized to house-dust mite (HDM).Methods: We conducted a retrospective analysis of 378 patients with HDM-sensitized AD. Among these patients, 164 received SCIT plus pharmacotherapy for 3 years (SCIT group) and the other 214 patients received only pharmacotherapy (non-SCIT group). The scoring atopic dermatitis (SCORAD) and pruritus visual analog scale (VAS) scores, laboratory test results, and adverse effects were recorded.Results: The SCORAD and pruritus VAS scores significantly decreased in the SCIT group. Also, the SCIT group showed higher reduction ratios of SCORAD and pruritus VAS scores than those observed in the non-SCIT group at 3 years after treatment initiation. The risk of development of new sensitization was higher in the non-SCIT group than in the SCIT group (relative risk 1.92 [95% confidence interval {CI}, 1.30-2.85]; p < 0.05). The eosinophil count of the participants significantly differed in the complete response (CR) group (p < 0.05) but not in the non-CR group (p = 0.098). However, the serum total immunoglobulin E value was not significantly reduced (p = 0.204). Of 8421 injections given to the patients, 231 injections (2.74%) showed adverse effects during the treatment period.Conclusion: Three years of SCIT can significantly reduce the severity and pruritus of moderate-to-severe AD with HDM sensitization. Patients who are multisensitized can also benefit from HDM SCIT. Patients can achieve long-term effects, such as prevention of neoallergen sensitization and inhibition of the allergy march.