Abstract：
BACKGROUND: Subcutaneous immunotherapy (SCIT) can induce systemic reactions (SRs) in certain patients, but the underlying mechanisms remain to be fully elucidated.
METHODS: AR patients who were undergoing standardized HDM SCIT (Alutard, ALK) between 2018 and 2022 were screened. Those who experienced two consecutive SRs were included in the study group. A control group was established, matched 1:1 by gender, age, and disease duration with the study group, who did not experience SRs during SCIT. Clinical and immunological parameters were recorded and analyzed both before SCIT and after 1 year of treatment.
RESULTS: A total of 161 patients were included, with 79 (49.07%) in the study group. The study group had a higher proportion of AR combined asthma (26.8% vs. 51.8%, p < 0.001) and higher levels of sIgE to HDM and HDM components (all p < .001). Serum IL-4 and IL-13 levels in the study group were higher than those in the control group (p < .05). The study group received a lower maintenance dosage of HDM extracts injections than control group due to SRs (50000SQ vs. 100000SQ, p < .05). After 1 year of SCIT, the VAS score, the lung function parameters of asthmatic patients over 14 years old significantly improved in both groups (all p < .05). After a 7-day exposure to 20 μg/mL HDM extracts, the percentages of Th1, Th17, Tfh10, and Th17.1 in PBMCs decreased, while the Tfh13 cells significantly increased in the study group (p < .05).
CONCLUSIONS: The type 2 inflammatory response is augmented in HDM-induced AR patients who experienced SRs during SCIT. Despite this, SCIT remains effective in these patients when administered with low-dosage allergen extracts.
METHODS: AR patients who were undergoing standardized HDM SCIT (Alutard, ALK) between 2018 and 2022 were screened. Those who experienced two consecutive SRs were included in the study group. A control group was established, matched 1:1 by gender, age, and disease duration with the study group, who did not experience SRs during SCIT. Clinical and immunological parameters were recorded and analyzed both before SCIT and after 1 year of treatment.
RESULTS: A total of 161 patients were included, with 79 (49.07%) in the study group. The study group had a higher proportion of AR combined asthma (26.8% vs. 51.8%, p < 0.001) and higher levels of sIgE to HDM and HDM components (all p < .001). Serum IL-4 and IL-13 levels in the study group were higher than those in the control group (p < .05). The study group received a lower maintenance dosage of HDM extracts injections than control group due to SRs (50000SQ vs. 100000SQ, p < .05). After 1 year of SCIT, the VAS score, the lung function parameters of asthmatic patients over 14 years old significantly improved in both groups (all p < .05). After a 7-day exposure to 20 μg/mL HDM extracts, the percentages of Th1, Th17, Tfh10, and Th17.1 in PBMCs decreased, while the Tfh13 cells significantly increased in the study group (p < .05).
CONCLUSIONS: The type 2 inflammatory response is augmented in HDM-induced AR patients who experienced SRs during SCIT. Despite this, SCIT remains effective in these patients when administered with low-dosage allergen extracts.
摘要：
背景：皮下免疫疗法（SCIT）可以在某些患者中引起全身反应（SRs），但是潜在的机制仍有待充分阐明。
方法：接受标准化HDMSCIT的AR患者（Alutard，ALK）在2018年至2022年之间进行了筛查。那些经历了两次连续SRs的人被纳入研究组。建立对照组,按性别1:1匹配，年龄,以及研究组的疾病持续时间，在SCIT期间没有经历SR的人。在SCIT治疗前和治疗1年后记录并分析临床和免疫学参数。
结果：共纳入161例患者，研究组79例（49.07%）。研究组AR合并哮喘的比例较高（26.8%vs.51.8%,p<0.001）和更高水平的sIgE对HDM和HDM组分（所有p<.001）。研究组血清IL-4和IL-13水平高于对照组(p<0.05)。由于SRs，研究组接受的HDM提取物注射维持剂量低于对照组(50000SQvs.100000SQ,p<.05)。在SCIT工作一年后，VAS评分，两组14岁以上哮喘患者的肺功能参数均明显改善（均p<0.05）。暴露于20μg/mLHDM提取物7天后，PBMC中Th1、Th17、Tfh10和Th17.1的百分比下降，而Tfh13细胞在研究组中显著增加(p<0.05)。
结论：在SCIT期间经历SRs的HDM诱导的AR患者中，2型炎症反应增强。尽管如此,当施用低剂量变应原提取物时,SCIT在这些患者中仍然有效。
方法：接受标准化HDMSCIT的AR患者（Alutard，ALK）在2018年至2022年之间进行了筛查。那些经历了两次连续SRs的人被纳入研究组。建立对照组,按性别1:1匹配，年龄,以及研究组的疾病持续时间，在SCIT期间没有经历SR的人。在SCIT治疗前和治疗1年后记录并分析临床和免疫学参数。
结果：共纳入161例患者，研究组79例（49.07%）。研究组AR合并哮喘的比例较高（26.8%vs.51.8%,p<0.001）和更高水平的sIgE对HDM和HDM组分（所有p<.001）。研究组血清IL-4和IL-13水平高于对照组(p<0.05)。由于SRs，研究组接受的HDM提取物注射维持剂量低于对照组(50000SQvs.100000SQ,p<.05)。在SCIT工作一年后，VAS评分，两组14岁以上哮喘患者的肺功能参数均明显改善（均p<0.05）。暴露于20μg/mLHDM提取物7天后，PBMC中Th1、Th17、Tfh10和Th17.1的百分比下降，而Tfh13细胞在研究组中显著增加(p<0.05)。
结论：在SCIT期间经历SRs的HDM诱导的AR患者中，2型炎症反应增强。尽管如此,当施用低剂量变应原提取物时,SCIT在这些患者中仍然有效。
