A Clinical Analysis Of Specific Immunotherapy On Allergic Rhinitis

Allergic rhinitis is one of the most common allergic diseases,which is common in otorhinolaryngology,has become a global health problem.There are four parts consists of the treatment system:①avoid contact with allergen②drug therapy③allergen specific immunotherapy④patient education。Avoid contact with allergen was the first-line intervention.The main purpose of drug treatment is to control symptoms.Immunotherapy is the only mechanism of immune regulation may change the natural course of allergic diseases.Although avoid contact with allergen should be the most effective way for allergic rhinitis,however,some allergens,particularly in airborne allergens are often difficult to avoid.Thus,drug treatment or immunotherapy is still an important means.Drug medication can only control the symptoms,not fundamentally adjust the patient's immune status.The immunotherapy as a biological response modifier is the only way to interfere with specific immune response and can change the natural course of allergic diseases.The World Health Organization recommended the use of immunotherapy.Its efficacy has been fully affirmed and called for the use of immunotherapy in the standardization of allergen specific immunotherapy vaccines.Dust mite allergen is commen in the world.It is the major allergens in our country caused allergic rhinitis and asthma.The research about dust mites has been depthly.The international standardization of dust mite allergen vaccines have been applied in some regions of China.Objective:To investigate the allergens in allergic rhinitis(AR) patients from the Province jilin,as to provide reliable data for prevention and management of AR. To evaluate the efficacy and safety of the standardized dust mites vaccine for the treatment of allergic rhinitis in the near future.Methods:1270 patients with AR were enrolled into the study.Skin prick test was used to detect the allergens in all patients.Retrospective analysis the outpatient treatment of patients in the department of Otolaryngology Head and Neck Surgery,China-Japan Union Hospital of Jilin University during 2006.9-2008.9.We selected the patients in accordance with perennial allergic rhinitis diagnostic criteria of Lanzhou(2004).The use of standardized house dust mite allergen preparation(Alutard SQ) in sterile conditions,in the upper arm from the elbow extensor hand side width,the use of a short trocar in the deep subcutaneous slow injection,a little to bring help to insert the subcutaneous skin deep,his arms turn injection.Doses from the beginning of the recommended low-dose,combined with gradually increasing doses of the individual.Dust mite allergen specific immunotherapy treatment includes two phases:dose cumulative dose treatment phase and maintenance treatment phase.Stage in the cumulative dose injected once a week in general.This stage will normally take 15 weeks. Cumulative dose phase of the maximum tolerated dose is the maintenance dose,it is recommended to maintain a dose of 100,000 SQ-U.Dose to achieve the maintenance dose after the injection of the first two weeks every other needle, and then every 4 weeks a second injection needle,and finally the third injection every 4-8 weeks,the four-pin(decided by the clinician).In 3-5 years and then every 4-8 weeks a maintenance dose injection.The patient's condition and treatment to assess the effectiveness and safety of the use of out-patient visit and telephone follow-up,and the establishment of personal data.Thirty six patients with allergic rhinitis caused by dust mites were selected in this self—contrast study.Clinical efficacy was evaluated by the symptom and sign scores after six months/one year of specific immunotherapy and compared with the pretreatment scores.And to take the test of matching the design of statistical analysis and other methods.Results:①The most common allergen was mites and mugwort in the province of jilin.②Effect:Thirty six patients completed the first six months of specific immunotherapy.A clinically significant reduction in the symptom and sign scores in these 36 patients comparing with these of pretreatment was founded,and the difference was significantly(P＜0.05).Twenty one patients completed the one years of specific immunotherapy.A clinically significant reduction in the symptom and sign scores in these 16 patients comparing with these of treatment after 6 months was founded,and the difference was signifieantly(P＜0.05).105 local adverse reactions and 9 systemic reactions had occurred in total 64 injections,③Relationship with asthma:This set of data showed that six cases of allergic rhinitis combined with asthma,accounting for 16.67 percent of the total number,by SIT treatment,nasal symptoms and asthma symptoms relieved in varying degrees,efficacy in patients with AR alone was no significant difference.④Allergens:Selected all cases the information allergen skin test examination, with the exception of house dust mite and dust mite allergens,most accompanied by varying degrees,positive for other allergens,but dust mites by specific immunotherapy,the vast majority of patients have symptoms remission or improvement,we can see the standardization of house dust mite allergen combined treatment of other mixed-mite allergen-positive patients with allergic asthma also effective.⑤Security:A total of 36 cases of patients 1 year of immunization in the treatment of injection of 642 times,105 times the local adverse reactions occur,the incidence of local adverse reactions 16.36%.Of these, 22 cases of adverse reactions in patients with localized,9 cases of systemic adverse reactions occurs,the occurrence of systemic adverse reaction rate of 1.40 percent,mainly for fever,mild asthma attacks,itchy eyes,etcand no fatal systemic reaction occurred.Conclusion:The most common allergen was mites and mugwort in the province of jilin,Which provides prevention and treatment of allergic rhinitis has been the basis of epidemiological data and clinical.Standardized allergen specific immunotherapy is an effective and safe treatment in patients suffering from allergic rhinitis due to dust mites.To enhance the effectiveness,it is recommended to complete the full course of treatment.At present,the medical profession has been completed and a lot of clinical trials,confirmed that the standardization of specific immunotherapy with the early symptoms of control, reduce drug use;continue to improve airway hyperresponsiveness and response CSD;the end of treatment to improve long-term symptoms and airway reactive role in the improvement;and the prevention of the emergence of new patients with allergy or hypersensitivity to increase(such as the development of rhinitis and asthma) in the clinical treatment of multi-level role.In short,the growing evidence suggested that allergy immunotherapy is a safe and effective treatment. With the development of science and technology,new methods and techniques of application of allergen formulations and mechanisms of improvement in further studies,especially for the pathogenesis of allergic diseases and immunological mechanism of SIT further in-depth understanding,may result in more effective treatment strategy to a more reasonable treatment of a safer and even cure allergic diseases.