Comparison of systemic reactions in rush, cluster, and standard-build aeroallergen immunotherapy
Comparison of systemic reactions in rush, cluster, and standard-build aeroallergen immunotherapy
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DOI：
10.1016/j.anai.2016.09.005
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发表时间：
2016-11-01
影响因子：
5.9
通讯作者：
Pollard, Stephen J.
中科院分区：
文献类型：
--
作者：
Winslow, Andrew W.;Turbyville, Joseph C.;Pollard, Stephen J.
背景：由于空气变应原免疫治疗可选择标准、集群和快速集聚疗法，标准架构免疫疗法通常被认为是首选，因为与集群和匆忙免疫疗法相关的系统反应(SRS)发生率较高。目的：描述5年间变态反应诊所标准、集群和快速集聚免疫疗法中SRS的发生率。方法：对2010年1月1日至2014年12月31日在肯塔基州路易斯维尔家庭过敏和哮喘诊所接受标准架构、8至10步集群免疫疗法或2天快速免疫疗法的患者进行回顾性分析。研究人员排除了在皮肤点刺试验、蛇毒免疫治疗和不真实的SRS期间发生的反应，并确定了建立方法、年龄、性别、反应日期、药瓶浓度和是否存在哮喘。结果：在我们的回顾期间，11,982名患者接受了2,549,643次注射。标准免疫疗法、聚集性免疫疗法和急救性免疫疗法的每例SR发生率分别为0.01%、0.06%和0.33%，标准、聚集性和急救性免疫疗法的每例SR发生率分别为2.84%、2.52%和11.86%。共有42%的SRs为1级，43%为2级，12%为3级，3%为4级。没有死亡报告。共有70%的SRs、75%的簇状SR和55%的Rush SR发生在女性中，5~10月SR出现高峰。结论：与以往报道的发病率相比，标准免疫、簇状免疫和急诊免疫治疗SR的发生率有所下降，高峰出现在5~10月，且以女性为主。(C)2016年美国过敏、哮喘和免疫学学院。爱思唯尔公司出版，版权所有。
Background: Given the choice of standard, cluster, and rush build-up for aeroallergen immunotherapy, standard-build immunotherapy has generally been preferred because of a perceived high rate of systemic reactions (SRs) associated with cluster and rush immunotherapy.Objective: To characterize the incidence of SRs during standard, cluster, and rush build-up immunotherapy in an allergy practice during a 5-year period.Methods: A retrospective review was conducted among patients receiving standard-build, 8- to 10-step cluster, or 2-day rush immunotherapy from January 1, 2010, through December 31, 2014, at Family Allergy & Asthma clinics in Louisville, Kentucky. Investigators excluded reactions that occurred during skin prick testing, venom immunotherapy, and not-true SRs, and identified the build-up method, age, sex, date of reaction, vial concentration, and presence of asthma. Per-shot and per-patient incidence of SRs was computed from these data.Results: During our review period, 2,549,643 injections were administered to 11,982 patients. Per-shot incidence of SR was 0.01%, 0.06%, and 0.33% for standard, cluster, and rush immunotherapy, respectively; per-patient incidence of SR was 2.84%, 2.52%, and 11.86% for standard, cluster, and rush immunotherapy, respectively. A total of 42% of SRs were grade 1, 43% were grade 2, 12% were grade 3, and 3% were grade 4. No fatalities were reported. A total of 70% of total SRs, 75% of cluster SR, and 55% of rush SR occurred in females, with an emergent peak in SR from May to October.Conclusion: Compared with previously published rates, we observed a decrease in the incidence of SR for standard, cluster, and rush immunotherapy, with peak seasonality from May to October and a female predominance. (C) 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.