Comparative Study On Subcutaneous Cluster And Conventional Immunotherapy In Allergic Rhinitis Patients With Mite Allergy

Objective: To compare the efficacy and safety of subcutaneous immunotherapy with Dermatophagoides Pteronyssinus standardized extract given in conventional and cluster immunotherapy schedules for persistent allergic rhinitis.And through the analysis of subjective and objective assessment,hoping to set up a more perfect evaluating system and make suitable treatment of patients with the personalized.Methods: Seventy patients with moderate to severe allergic rhinitis caused by dust mites,who visited in the affiliated hospital of medical school of Ningbo university during August 2018 to December 2019 and were willing to receive the immunotherapy and participate this study.They were allocated to receive conventional immunotherapy schedule or cluster immunotherapy schedule,and both groups continued treatment for 4 months.Subjective assessment(including symptom score,drug dosage score and life score)and objective assessment(concentration of the serum Der p IgE、Der f IgE and Der p IgG4)were used to evaluate the clinical efficacy,and the incidence of systemic adverse reactions were registered to evaluate the safety.Results: 1.Among these patients,63 patients completed the 4 months’ follow-up visit,including 34 of the conventional immunotherapy group and 29 of the cluster immunotherapy group.In terms of VAS score of symptoms,nasal symptom score and total symptoms score in the two groups,and ocular symptom score in the cluster immunotherapy group all improved after treatment(P<0.05),while ocular symptom score in the conventional immunotherapy group and chest symptom score in the two groups did not improve significantly after treatment(P>0.05).The degree of changes in nasal symptom,ocular symptom,chest symptom,and total symptoms score during the 4 months’ treatment between the two groups made no difference(P>0.05).2.Both groups reduced the use of drugs after the treatment(P<0.05).The degree of change in drug dosage score of cluster immunotherapy group was higher than that of conventional immunotherapy group(P<0.05).3.The quality of life in both groups improved greatly after the treatment(P<0.05).There was no difference in the degree of change in life score between the two groups during the treatment(P > 0.05).4.There was no difference in the concentration of serum Der p IgE and Der f IgE between the two groups before and after the treatment(p>0.05).After the immunotherapy,the concentration of serum Der p IgG4 in both groups was higher than that before the treatment(p < 0.05),and the degree of concentration’s elevation in the cluster immunotherapy group was higher than that in the conventional immunotherapy group(p>0.05).5.Correlation analysis: The change of total VAS score was significantly correlated with the serum Der p IgG4(R=0.245,p<0.05).There was no correlation between total VAS score and serum Der p IgE(p>0.05).Correlation was also found between serum Der p IgE with serum Der p IgG4(R=0.307,p<0.05).6.In the conventional immunotherapy group,34 patients totally received 544 injections,the incidence rate of adverse reactions was 0.92%(5/544).In the cluster immunotherapy group,29 patients received 261 injections,the incidence rate of adverse reactions was 0.77%(2/261).There was no difference in the incidence of systemic adverse reactions between the two groups(2=0.002,P =0.962).Conclusion: In the subcutaneous immunotherapy of allergic rhinitis,both cluster and conventional immunotherapy showed great improvement in symptoms after 4 months’ treatment,with less use of drugs and fewer adverse reactions,so they were comparable in efficacy and safety.But in some aspects,it indicates that the cluster immunotherapy can reduce the number of patients’ visit to hospital with a safe,effective and fast treatment plan.We also find that the serum Der p IgG4 has the potential to be used to evaluate the initial efficacy of subcutaneous immunotherapy.