COMBINATION OF PASSIVE AND ACTIVE IMMUNIZATION IN HONEYBEE VENOM IMMUNOTHERAPY
COMBINATION OF PASSIVE AND ACTIVE IMMUNIZATION IN HONEYBEE VENOM IMMUNOTHERAPY
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DOI：
10.1016/0091-6749(87)90245-4
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发表时间：
1987-06-01
影响因子：
14.2
通讯作者：
MICHEL, FB
中科院分区：
文献类型：
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作者：
BOUSQUET, J;FONTEZ, A;MICHEL, FB
蜂毒（HBV）免疫疗法在最佳条件下是有效的，但当毒液剂量增加时，尤其是在紧急方案中，会观察到许多不良的全身反应。尽管患者之间存在较大差异，但发现血清蜂毒特异性 IgG 水平与过敏患者的保护显着相关。进行了一项双盲安慰剂对照研究，以确定使用来自养蜂人血清库的分级 IgG 进行被动免疫是否能够（1）保护接受 HBV 快速免疫治疗计划的患者免受不良全身反应，以及（2）观察 HBV 主动免疫是否可以引发针对毒液过敏原的主动 IgG 免疫反应。从养蜂人血清库（Cohn 级分 II 至 III）中获得超免疫 IgG，随后用胃蛋白酶处理以供静脉内使用。发现制剂中存在所有 IgG 亚类。 27 名对 HBV 高度过敏的患者被随机分配到两个治疗组。 20 名患者接受了 10 至 15 克的分级 IgG，另外 7 名患者以双盲方式接受了生理盐水。第二天，3 小时的紧急方案试图达到 200 微克的累积毒液剂量；接受分级 IgG 的患者中有 16/20 达到了该剂量而没有任何全身反应，而接受生理盐水的 7 名受试者均未达到该剂量，并且所有患者均出现了全身反应。在达到维持剂量的患者中，治疗 1 周后，主动免疫 HBV 引起毒液 IgG 显着增加（p < 0.05；Wilcoxon W 检验）。该组中的毒液 IgG 随后增加。在接受盐水治疗的患者组中，观察到毒液 IgG 出现类似的增加； 21/27 的患者在达到维持剂量后 3 周至 2 个月内被蜜蜂蜇伤。所有患者均未出现全身反应。事实证明，IgG 被动免疫可以显着保护患者免受主动免疫治疗的全身反应，当患者在接近蜜蜂季节时出现过敏反应时，被动和主动免疫治疗的组合可以作为替代方案。
Immunotherapy with honeybee venom (HBV) is effective under optimal conditions, but many untoward systemic reactions are observed when venom doses are increased, especially with rush protocols. Although there were large interpatient variations, the levels of serum bee venom specific IgG were found to significantly correlate with the protection of the allergic patients. A double-blind, placebo-controlled study was carried out to determine whether passive immunization with fractionated IgG from a beekeeper''s serum pool was able (1) to protect patients undergoing a rush immunotherapy program with HBV against untoward systemic reactions, and (2) to observe if the active immunization with HBV could elicit an active IgG immune response toward venom allergens. Hyperimmune IgG was obtained from a pool of sera of beekeepers (Cohn fractions II to III) that was subsequently treated with pepsin for intravenous use. All IgG subclasses were found to be present in the preparation. Twenty-seven patients, highly allergic to HBV, were randomly allocated to two treatment groups. Twenty patients received 10 to 15 gm of fractionated IgG, and seven other patients received saline in a double-blind fashion. The next day, a 3-hour rush protocol attempted to reach a cumulative venom dose of 200 .mu.g; 16/20 patients who received the fractionated IgG reached this dose without any systemic reaction, whereas none of the seven subjects who received saline could attain it, and all patients had a systemic reaction. The active immunization with HBV elicited a significant (p < 0.05; Wilcoxon W Test) increase in venom IgG after 1 week of treatment in the patients who reached the maintenance dose. Venom IgG was subsequently increased in this group. In the group of patients who received saline, a similar increase in venom IgG was observed; 21/27 patients were stung by honeybees between 3 weeks and 2 months after the maintenance dose had been reached. None of the patients had a systemic reaction. Passive immunization with IgG was demonstrated to protect, significantly, patients against systemic reactions of active immunotherapy, and the combination of passive and active immunotherapy can be used as an alternative when patients develop an allergic reaction close to the bee season.