PDF(Pubmed)
Abstract：
Allergen immunotherapy (AIT) is the only treatment which acts on the causes of allergic diseases by modifying their natural history. In the eighties subcutaneous immunotherapy (SCIT) with high biological power allergen extracts caused a number of severe systemic reactions and also fatalities in the UK and the US, resulting in its limitation and in the introduction of other routes of administration. A decisive advance for SCIT safety was understanding that the major cause of mortality was injecting the allergen extract to patients with uncontrolled asthma at the time of injection.
This awareness resulted in a significant decrease in fatalities, but not in their abolition. In 2019, an increase in SCIT-related mortality was observed, suggesting to continue the research for still unidentified factors favoring severe reactions, such as the administration of a wrong extract or of allergen doses higher than listed, unintentional intravenous administration, and missed dose reduction after protracted interruption. Moreover, in the context of the improving of the safety, the role played in tolerance-promoting by adjuvants such as CpG oligodeoxynucleotides has to be taken into account, as well as the potential preventive effect performed by the monoclonal anti-IgE antibody omalizumab against the exacerbation of severe reactions during SCIT.
The safety of SCIT is good, but the research to improve it further must continue. In particular, the pathophysiological mechanisms related to AIT for inhalants and for Hymenoptera venom should be studied, based on the evident diversity demonstrated by the complete absence of fatal reactions to Hymenoptera venom immunotherapy from its introduction in comparison with the history of serious and fatal offenses examined in this review.
This awareness resulted in a significant decrease in fatalities, but not in their abolition. In 2019, an increase in SCIT-related mortality was observed, suggesting to continue the research for still unidentified factors favoring severe reactions, such as the administration of a wrong extract or of allergen doses higher than listed, unintentional intravenous administration, and missed dose reduction after protracted interruption. Moreover, in the context of the improving of the safety, the role played in tolerance-promoting by adjuvants such as CpG oligodeoxynucleotides has to be taken into account, as well as the potential preventive effect performed by the monoclonal anti-IgE antibody omalizumab against the exacerbation of severe reactions during SCIT.
The safety of SCIT is good, but the research to improve it further must continue. In particular, the pathophysiological mechanisms related to AIT for inhalants and for Hymenoptera venom should be studied, based on the evident diversity demonstrated by the complete absence of fatal reactions to Hymenoptera venom immunotherapy from its introduction in comparison with the history of serious and fatal offenses examined in this review.
摘要：
过敏原免疫疗法（AIT）是唯一通过改变其自然史而对过敏性疾病的病因起作用的治疗方法。在80年代，使用高生物力过敏原提取物的皮下免疫疗法（SCIT）在英国和美国引起了许多严重的全身反应和死亡，导致其局限性和其他给药途径的引入。SCIT安全性的决定性进步是了解死亡的主要原因是在注射时将过敏原提取物注射到未控制的哮喘患者。
这种意识导致死亡人数显著减少，但不是废除。2019年，观察到SCIT相关死亡率上升，建议继续研究仍然未知的有利于严重反应的因素，例如施用错误的提取物或高于所列的过敏原剂量，无意的静脉给药，以及长期中断后错过的剂量减少。此外，在提高安全性的背景下，必须考虑到CpG寡脱氧核苷酸等佐剂在促进耐受性方面的作用，以及单克隆抗IgE抗体奥马珠单抗对SCIT期间严重反应加重的潜在预防作用。
SCIT的安全性很好，但是进一步改进它的研究必须继续。特别是,应研究与AIT有关的吸入剂和膜翅目毒液的病理生理机制，基于明显的多样性，从膜翅目毒液免疫疗法的引入中完全没有致命的反应，与这篇综述中检查的严重和致命罪行的历史相比。
这种意识导致死亡人数显著减少，但不是废除。2019年，观察到SCIT相关死亡率上升，建议继续研究仍然未知的有利于严重反应的因素，例如施用错误的提取物或高于所列的过敏原剂量，无意的静脉给药，以及长期中断后错过的剂量减少。此外，在提高安全性的背景下，必须考虑到CpG寡脱氧核苷酸等佐剂在促进耐受性方面的作用，以及单克隆抗IgE抗体奥马珠单抗对SCIT期间严重反应加重的潜在预防作用。
SCIT的安全性很好，但是进一步改进它的研究必须继续。特别是,应研究与AIT有关的吸入剂和膜翅目毒液的病理生理机制，基于明显的多样性，从膜翅目毒液免疫疗法的引入中完全没有致命的反应，与这篇综述中检查的严重和致命罪行的历史相比。
