舌下含服粉尘螨滴剂免疫治疗儿童多种变应原过敏哮喘鼻炎的疗效研究

目的探讨舌下含服尘螨变应原疫苗对多种变应原过敏哮喘鼻炎儿童治疗的临床疗效。方法选291例年龄4～13岁哮喘缓解期伴变应性鼻炎患儿为免疫治疗对象,根据皮肤点刺试验结果分成尘螨过敏组(80例)、尘螨及蟑螂过敏组(71例)、尘螨及花粉过敏组(74例)、尘螨及狗毛过敏组(66例)共4组。全部病例完成包括尘螨在内的10种常见过敏原皮肤点刺实验,点刺试验后观察阳性反应。应用浙江我武生物科技有限公司提供的"粉尘螨滴剂"进行临床免疫治疗,记录治疗前后症状和体征评分以及不良反应。结果哮喘并变应性鼻炎完成1年免疫治疗的总有效率为62.5%,其中尘螨过敏组为53.8%,尘螨及蟑螂过敏组为66.2%,尘螨及花粉过敏组为70.3%,尘螨及狗毛过敏组为60.6%。各治疗组间有效率比较差异无统计学意义(x~2=5.107,P0.05)。与用药有关的皮疹、鼻咽痒和哮喘发作的不良反应发生率为23.67%,未出现过敏性休克的严重副作用。结论舌下含服尘螨变应原疫苗对单一变应原和多种不同变应原混合过敏的哮喘和鼻炎儿童免疫治疗是安全有效的。     

济南地区280例变应性鼻炎患者的变应原分析

目的探讨济南地区变应性鼻炎变应原分布特点。方法取280例济南地区变应性鼻炎患者,采用变应原皮肤点刺试验确定变应原。结果本组210例（75%）患者变应原皮肤点刺试验阳性,其中屋尘螨和粉尘螨阳性检出率最高,分别为75.2%和78.1%,2种以上变应原阳性188例（89.5%）。结论 济南地区变应性鼻炎患者最常见变应原为尘螨。     

舌下含服粉尘螨滴剂治疗多重过敏的过敏性哮喘的临床评价

目的观察标准化粉尘螨滴剂舌下特异性免疫治疗(SLIT)对多重过敏的过敏性哮喘(AS)的疗效及安全性。方法收集接受规则治疗2年且随访资料完整的轻、中度AS患者141例,按皮肤点刺试验结果及患者治疗意愿,分为单一尘螨过敏免疫治疗组(单一免疫组)41例、多重过敏免疫治疗组(多重免疫组)51例和多重过敏常规治疗组(多重常规组)49例。3组均应用小至中等剂量的吸入型糖皮质激素+长效β2受体激动剂,免疫组在此基础上给予粉尘螨滴剂SLIT,进行2年的随访观察,评价疗效。结果治疗2年后,多重免疫组的症状评分、用药评分显著低于多重常规组,ACT评分显著高于多重常规组(P0.05)。治疗2年后,多重免疫组的各项指标与单一免疫组比较差异均无统计学意义(P0.05)。多重免疫组与SLIT有关的不良反应发生率为9.80%,与单一免疫组类似(9.76%)。结论标准化粉尘螨滴剂综合药物治疗多重过敏的AS患者,较常规药物更能明显改善哮喘症状,减少药物使用,提高哮喘控制水平,可达到单一过敏患者的相似的治疗效果,未发生严重不良反应。     

阿罗格变应原皮肤点刺试验在变应性疾病诊断中的临床意义

目的　探讨阿罗格变应原皮肤点刺试验在变应性疾病诊断中的临床价值。方法　用 2 0种德国默克公司阿罗格变应原进行皮肤点刺试验 ,以生理盐水为阴性对照 ,组胺为阳性对照。结果　临床拟诊为变应性疾病的2 0 0 0例患者中 ,粉尘螨、屋尘螨的阳性率分别为 4 1.4 0 %和 4 0 .6 0 % ,其他 18种变应原的阳性率为 0 .4～ 2 8.6 % ,阳性对照的阳性率为 6 %。变应性鼻炎组粉尘螨和屋尘螨分别为 73.2 0 %和 71.36 % ,狗上皮为 33.5 4 % ;哮喘组粉尘螨和屋尘螨为 5 1.4 %和 4 9.4 4 % ,食物组以咖哩和小虾多见。选择螨类及其他变应原阳性的患者 5 0例行脱敏治疗 ,4 8例显效 ,疗效满意。结论　阿罗格变应原皮肤点刺试验为变应性疾病的诊断提供有力的依据 ,为特异性脱敏治疗提供可靠的客观指标。具有方便安全、操作简单、假阳性少、多种变应原可同时检测、特异性高等优点。     

粉尘螨滴剂治疗儿童尘螨过敏性结膜炎的疗效观察

目的评价粉尘螨滴剂治疗儿童尘螨过敏性结膜炎的疗效和安全性。方法选择55例尘螨过敏性结膜炎患儿,随机分为对照组与实验组,对照组发作期口服抗组胺药,外滴色干酸钠眼药水,实验组在对照组基础上加舌下含服粉尘螨滴剂脱敏治疗。结果对照组显效7例31．8％）,有效9例（40．9％）,无效6例（27．3％）,总有效率72．7％;实验组显效22例（66．7％）,有效7例（21．2％）,无效4例（12．1％）,总有效率87．9％,两组比较差异有统计学意义（P〈0．05）。不良反应：1例患儿在使用3号第6滴时出现轻度哮喘发作,3例患儿出现眼部及鼻炎症状加重,5例局部不良反应,如口、舌或唇的轻微肿胀,无全身不良反应发生。结论舌下含服粉尘螨滴剂脱敏治疗儿童尘螨过敏性结膜炎是一种安全、有效的治疗方法。     

变应性鼻炎屋尘螨变应原皮试结果比较分析

目的 比较分析变应性鼻炎患者不同产地屋尘螨变应原在变应性鼻炎的皮试结果.方法 306例中重度持续性变应性鼻炎患者,随机分组进行国产屋尘螨变应原皮内试验或国际标准阿罗格屋尘螨变应原皮肤点刺试验.结果 国产屋尘螨变应原皮内试验阳性率88.69%(137/154),阿罗格屋尘螨变应原点刺法试验阳性率90.79%(138/152),两者间差异无统计学意义(P>0.05);国产屋尘螨变应原IDT阳性达(+ +)及以上为62.34%(96/154),阿罗格屋尘螨变应原SPT阳性达(+ +)及以上为84.87%(129/152),两者间差异有统计学意义(P＜0.001).无严重不良反应发生.结论 国产屋尘螨变应原和阿罗格屋尘螨变应原均具有较高的阳性率,阿罗格屋尘螨变应原点刺法试验具有更高的灵敏性及特异性.     

上海粉尘螨变应原及特异性免疫治疗(英文）

我国螨性变态反应的研究开始于1970年代上海第一医学院（现为复旦大学上海医学院）。上海当地的粉尘螨螨种制备的变应原SMU-Df,其过敏活性与国外同种比较,超过许多倍属于最高的,包括美国食品药品管理局参考品、弗吉尼亚大学标准品、丹麦哥本哈根变态反应研究所标准质量品等。SMU-Df 经凝胶层析所显示的蛋白峰曲线型与粉尘螨代谢培养基者基本相似,其变应原性也相仿。过敏病例可用皮肤点刺试验、鼻腔激发试验和血清IgE水平测定方法诊断,80%左右的过敏患者呈阳性反应。粉尘螨注射液是我国第一种由卫生主管部门批准生产的商品变应原,用传统的皮下注射免疫治疗,通过季节性脱敏,大多数患者可减轻过敏症状,具有极好的疗效。尘螨特异性免疫治疗具有远期疗效而无严重不良反应。对于粉尘螨粗抗原的改良处方和不同给药途径进行过研究,尤其舌下含服粉尘螨滴剂制备和临床应用从1992年与国外同步开始,对于儿童尤其适用而无年龄限制,疗效极好。螨苗冲击特异性免疫疗法具有快速改善过敏症状且有远期疗效。粉尘螨变应原具有诱导人体免疫调节作用,不论过敏患者或健康人群都产生免疫应答。     

辽宁地区变应性鼻炎患者吸入变应原谱分析

目的了解辽宁地区变应性鼻炎患者的变应原种类、分布特征、变应原反应强度及其与变应性鼻炎发病的关系。方法用20种变应原对辽宁地区4995例鼻炎初诊患者进行皮肤点刺试验（skin prick test,SPT）。结果鼻炎患者中变应原SPT阳性率为53.9%（2697/4995）,其中1种变应原阳性率占9.3%（250/2697）,2种以上占90.7%（2447/2697）。变应原SPT阳性率分布在前4位的是粉尘螨、屋尘螨、艾蒿、豚草花粉,其他依次为狗毛、混合树木、蟑螂、猫毛、葎草、霉菌。粉尘螨、屋尘螨的SPT阳性率,儿童（55.0%、52.8%）高于成人（24.9%、21.3%）,P均〈0.001;男性（18.9%、17.0%）高于女性（12.5%、11.1%）,P均〈0.01。艾蒿、豚草SPT阳性率,成人（27.8%、19.4%）明显高于儿童（15.8%、9.5%）,P均〈0.01;成人男性（31.4%、22.1%）高于女性（25.2%、17.5%）,P均〈0.01。15～34岁年龄组SPT阳性率占优势。结论尘螨为辽宁地区常年性变应性鼻炎的首位变应原,儿童阳性率高于成人;艾蒿、豚草为季节性变应性鼻炎的主要变应原,成人阳性率高于儿童。     

舌下含服粉尘螨滴剂治疗变应性哮喘的临床研究

目的探讨粉尘螨口含滴剂治疗变应性哮喘的疗效。方法对符合变应性哮喘诊断标准并且粉尘螨变应原皮肤点刺试验呈阳性的患者用粉尘螨口含滴剂治疗。从低剂量起逐步递增,比较治疗前后最大呼气流量（PEF）、第一秒用力呼气肺活量占预计值的百分比（FEV1%）以及血和痰中嗜酸性粒细胞计数（EOS）、粉尘满的特异性IgE（sIgE）。结果 FEV1%、PEF与粉尘螨治疗前相比均显著增加（P〈0.05）,血与痰中EOS及血sIgE与治疗前相比均明显下降（P〈0.01）。结论粉尘螨口含滴剂免疫治疗对变应性哮喘具有良好的治疗效果,能显著改善变应性哮喘患者的肺功能。     

89例RRTI儿童过敏原检测及脱敏治疗临床分析

目的探讨变应原在儿童反复呼吸道感染(recurrent respiratory tract infections,RRTI)发病中的作用,观察变应原脱敏治疗对控制儿童RRTI的效果。方法采用德国默克公司的阿罗格变应原检测试剂盒对89例RRTI患儿与43名健康对照儿童进行变应原筛查,对检测结果进行统计学分析。对其中14例尘螨过敏的RRTI患儿进行脱敏治疗,总疗程48～52周,完成治疗后随访1年,对比脱敏治疗前后患儿呼吸道感染的发病频次。结果89例RRTI患儿中对一种或多种变应原产生阳性反应的患儿为85例,其中产生(++)以上阳性反应的患儿为63例(70.79%);最常见的前4种变应原依次为屋尘螨41例(65.08%)、粉尘螨32例(50.7%)、杂草10例(15.8%)和霉菌8例(12.7%)。43名健康对照儿童对一种或多种变应原产生阳性反应的患儿为9例,其中产生(++)以上阳性反应的儿童为4例(9%),明显低于RRTI患儿(P<0.05)。14例完成脱敏治疗的患儿,治疗前后人均患呼吸道感染次数由(8.2±2.6)次/年下降至(3.6±1.5)次/年。结论RRTI患儿对变应原的敏感性明显高于对照组,提示变应原是诱发儿童RRTI的重要原因;对RRTI患儿进行变应原的脱敏治疗是治疗儿童RRTI的有效方法。     

皮下注射标准化屋尘螨变应原疫苗治疗支气管哮喘和（或）变应性鼻炎的速发不良反应

摘要：目的分析应用标准化屋尘螨变应原对变应性哮喘和（或）变应性鼻炎进行皮下特异性免疫治疗（subcutaneous specific immunotherapy,SCIT）的速发不良反应。方法回顾性记录广州医科大学附属第一医院变态反应科2004年11月至2012年5月对屋尘螨过敏的哮喘和（或）变应性鼻炎患者接受SCIT过程中出现的速发不良反应,并分析速发不良反应与注射剂量、患者年龄、性别、患病种类和变态反应程度的关系。结果研究共纳入462例患者,其中452例（97．8％）出现速发局部不良反应,153例（33．1％）出现速发全身不良反应;所有患者共接受15645针次皮下注射,其中8523针次（54．5％）出现速发局部不良反应,397针次（2．5％）出现速发全身不良反应。速发局部不良反应发生率随剂量增加而增高,而速发全身不良反应主要分布在剂量上升阶段（2000～80000 SQU）。单纯哮喘及哮喘合并变应性鼻炎的速发不良反应（局部和全身）的发生率高于单纯变应性鼻炎（P〈0．01）。儿童速发局部不良反应发生率高于成人（P〈0．001）,但速发全身不良反应的发生率在儿童及成人患者间差异无统计学意义（P〉0．05）。儿童患者中,男性速发不良反应发生率高于女性（P〈0．01）;而在成人患者中,女性速发不良反应发生率高于男性（P〈0．01）。速发不良反应（局部和全身）的发生率随着屋尘螨特异性IgE级别的增高而升高（P〈0．001）;在皮下注射过程中出现速发全身不良反应者治疗前总IgE[（634．24±883．91）U／ml]与未发生速发全身不良反应者治疗前总IgE[（416．60±438．59）U／ml]比较,差异有统计学意义（t=2．008,P=0．048）。结论对屋尘螨过敏的哮喘和（或）变应性鼻炎患者进行标准化屋尘螨变应原的SCIT时,速发局部不良反应常见,而速发全身不良反应少见,哮喘和鼻炎合并哮喘、少年男性、成年女性及屋尘螨特异性IgE和总IgE水平较高时,速发不良反应的发生率增高,且随注射变应原剂量递增而存在增高趋势,剂量快速上升阶段应警惕严重不良反应的发生。     

北京地区尘螨过敏患者家庭螨类调查

目的调查北京地区尘螨过敏患者家庭螨类种类和比例,为北京地区尘螨防治提供理论依据。方法以北京协和医院就诊的38例北京地区尘螨过敏患者为研究对象,于2008年12月至2010年1月人户吸尘采集其所在家庭室内尘土样本,采用漂浮法收集尘土中的螨,分离制片,显微镜下分类计数并绘图。结果 38个家庭共采集样本345份,螨检出率为64.6%;经分离鉴定得出蜱螨亚纲3目12科15属22种,其中丝泊尘螨为我国致敏螨类一新纪录种;昆虫纲啮虫目1科1属2种。在分析的1798个标本中,主要致敏螨种前3位的依次为粉尘螨(62.46%),户尘螨(21.47%)和丝泊螨(5.28%)。对不同采集地点的调查结果表明,平房(91.1%)样本阳性率高于楼房(59.5%)。对不同生活环境螨密度的数据分析表明,枕头的平均螨密度最高,达到282只螨/克尘土,其次为床褥(120只螨/克尘土)和沙发(115只螨/克尘土)。平均螨密度在9至10月达最高峰,5至7月和12月至次年1月也出现2个高峰,3月和11月密度最低。结论本研究首次发现并报道了北京地区存在的丝泊尘螨,亦属于亚洲首次报道。北京地区室内优势螨种为粉尘螨,其次为屋尘螨和丝泊尘螨,平均螨密度在9至10月达最高峰。     

Mite immunotherapy

Dermatophagoides pteronyssinus and D. farinae are the most common house dust mites and are among the most common sources of indoor allergens worldwide. These species are very common in humid regions, where most allergic individuals are sensitized to house dust mites. Specific immunotherapy with mite extracts has demonstrated clinical benefits in several doubleblind, placebo-controlled trials that are included in recent reviews of subcutaneous immunotherapy, including pediatric and adult patients with rhinoconjunctivitis and or asthma. Most successful studies of mite immunotherapy have used native allergen extracts adsorbed onto aluminum hydroxide, or chemically modified mite-allergen extracts. Several studies have also shown ef.cacy using sublingual immunotherapy in pediatric and adult patients with asthma and/or rhinitis. Additionally, the ef.cacy of subcutaneous immunotherapy has been demonstrated in patients with atopic dermatitis, although more double-blind, placebo-controlled studies are needed. Based on several studies, it cannot be concluded that mite immunotherapy is more dangerous or safer than immunotherapy with grasses, epithelia, or animal epithelia. Because the delivery of high doses of allergen carries with it the risk for immunoglobulin E (IgE)-mediated events, several methods have been developed to reduce specific IgE binding to mite-allergen extracts. An important challenge for future mite immunotherapy modalities is the delivery of relatively high doses without a significant risk for severe reactions.     

House dust mites in the city of Lima, Peru.

Since mites are the most common house dust allergens, knowledge about the species most prevalent in a region is important for diagnostic and specific immunotherapy purposes. In order to establish the prevalence of house dust mites in different city districts, 100 house dust samples were collected from different parts of Lima. Lima is a city of tropical climate located along the coast of the Pacific Ocean. The relative air humidity is 80-90% and the various districts studied are located at altitudes ranging from 37-355 meters. The mite Blomia tropicalis was the organism most frequently detected, being present in 59% of the house dust samples. Dermatophagoides pteronyssinus occupied second place (15.9%), followed by Chortoglyphus arcuatus and Tyrophagus putrescentiae. These four mites, taken together, represented more than 90% of the mites detected. No specimen of the species Dermatophagoides farinae was detected. We conclude that B. tropicalis and D. pteronyssinus are the most common house dust mites in Lima. Considering the high prevalence of B. tropicalis in Lima and the fact that its cross-reactivity with antigens of the mites of the family Pyroglyphidae is minimal, we conclude that sensitization to this mite should be investigated separately in allergic patients living in Lima.     

Prevention of new sensitizations by specific immunotherapy in children with rhinitis and/or asthma monosensitized to house dust mite.

BACKGROUND: Previous studies have suggested that single-allergen-specific immunotherapy (SIT) may prevent sensitization to other airborne allergens in monosensitized children. We aimed to assess the prevention of new sensitizations in monosensitized children treated with single-allergen SIT injections in comparison with monosensitized patients given appropriate pharmacologic treatment for their disease. METHODS: A total of 147 children with rhinitis and/or asthma monosensitized to house dust mite were studied; 45 patients underwent SIT with adsorbed extracts and 40 patients underwent SIT with aqueous extracts for 5 years. The control group was comprised of 62 patients given only pharmacologic treatment for at least 5 years. Skin prick tests, medication scores for rhinitis and asthma, and atopy scores according to skin prick tests were evaluated at the beginning and after 5 years of treatment. RESULTS: All groups were comparable in terms of age, sex, and disease characteristics. At the end of 5 years, 64 out of 85 (75.3%) in the SIT group showed no new sensitization, compared to 29 out of 62 children (46.7%) in the control group (P = .002). There were no differences between the SIT subgroups with regard to onset of new sensitization (P = .605). The patients developing new sensitizations had higher atopy scores (P = .002) and medication scores for both rhinitis (P = .008) and asthma (P = .013) in comparison to patients not developing new sensitizations after 5 years of SIT. CONCLUSION: According to our data, SIT has the potential to prevent the onset of new sensitizations in children with rhinitis and/or asthma monosensitized to house dust mite.     

Correlation of environmental mite levels and the symptoms of allergic rhinitis regarding the efficacy of preventive education

Allergic rhinitis is still a commonly investigated disease all over the world. Allergens are usually in the nature of glycoprotein or protein which interact with antibodies resulting in the formation of specific Ig E in the body 1. It is presumed that some environmental factors play an important role in their clinics. In allergic rhinitis, symptoms usually occur after the interaction of nasal mucosa with allergens. Allergens may be indoors, outdoors or in both environments. House-dust contains most of the indoor allergens. Mites are the most egregious allergen in house dust. D. pteronyssinus is commonly seen in European countries, D. farinae is mostly seen in North America. House-dust mites play an important role in allergic sensitization of individuals in Turkey. Perennial allergic rhinitis is a common chronic disorder that results most frequently from sensitivity to house-dust mites. National and international guidelines for the management of allergic rhinitis recommend that house and dust mite avoidance measures be considered for all patients with house-dust mite provoked rhinitis. Symptoms of allergic rhinitis are related to the environmental mite level in which patients live. The aim of this study is to show the relationship between mite levels and symptoms of allergic rhinitis diagnosed patients and the change of mite levels in the environment after appropriate education.     

Sublingual immunotherapy to house dust mite in pediatric patients with allergic rhinitis and asthma: a retrospective analysis of clinical course over a 3-year follow-up period.

BACKGROUND AND OBJECTIVE: Specific allergen immunotherapy is believed to be the only treatment able to change the natural history of allergic airway diseases. Sublingual immunotherapy (SLIT) is especially preferred because of its easy application and safety. The aim of this study was to describe the effect of SLIT in pediatric patients who have allergic airway disease. METHODS: Children with asthma and rhinitis who were allergic to house dust mite were evaluated. The effect on clinical course of 3 years of SLIT with 50% Dermatophagoides pteronyssinus and 50% Dermatophagoides farinae in a standardized extract was assessed retrospectively. RESULTS: The records of 39 patients (23 boys, 16 girls) were studied. The mean (+/- SD) age for starting SLIT was 8.8 +/- 2.3 years. The mean number of acute asthma attacks at the onset of the disease was 8.18 +/- 3.05. The mean number of attacks after 3 years of SLIT was 0.44 +/- 0.79. There was a statistically significant difference in the number of acute asthma attacks before and after therapy (P < .001). Complete clinical remission of asthma was recorded in 37 (95%) patients. Similarly, complete clinical remission of allergic rhinitis was recorded in 32 (82%) patients. CONCLUSION: This retrospective study shows that SLIT is effective in children who have allergic airway disease which cannot be controlled effectively with allergen avoidance measures only.