Öz
Amaç: Alerjen spesifik immünoterapi uygulamaları sırasında çeşitli lokal veya nadirde olsa ölüme kadar gidebilen sistemikreaksiyonların ortaya çıkabileceği bilinmektedir. Çocukluk yaş grubunda klasik subkutan spesifik allerjen immünoterapisiuygulanan olgularda olası reaksiyonları araştırmak amacıyla bu çalışma planlanmıştır.Gereç ve Yöntem: Uludağ Üniversitesi Tıp Fakültesi, Çocuk Alerji Bilim Dalı polikliniğinde 1999-2007 yılları arasında ev tozu akarları karışımı D.Pteronyssinus %50, D. Farinae %50 , veya otlar/ tahıllar polen karışımı Grasses-Cereals; çayır polenleri %55, arpa %10, yulaf %10, çavdar %15, buğday %10 karışımı ile immünoterapi tedavisi alan olgular rastgele seçilerek çalışmaya alınmış, immünoterapi kayıtları retrospektif olarak incelenmiştir. Enjeksiyon bölgesinde 2-5 cm arası ödemve/veya eritem “lokal reaksiyon”, 5 cm’den büyük ödem ve/veya eritem “geniş lokal reaksiyon” olarak tanımlanmıştır. Ürtiker, anjioödem, bronkospazm, astım atağı, laringospazm, ciddi anafilaksiden en az birinin görülmesi “sistemik reaksiyon”olarak kabul edilmiştir.Bulgular: Çalışmaya alınan toplam 132 olgudan 85’si astım, 22’si alerjik rinit ve/veya alerjik rinokonjuktivit, 25’i astım ile birlikte alerjik rinit ve/veya alerjik rinokonjuktivit tanıları ile tedavi ve takip altındaydı. Olguların 68’ine akar karışımı ve 64’üneotlar/tahıllar karışımı ile immunoterapi uygulanmıştı.Çalışmaya alınan 132 olguya toplam 7110 ortalama 51,8±16,7 alerjen enjeksiyonu uygulandığı saptandı. Lokal reaksiyon,olguların 35’inde %26,5 ve tüm enjeksiyonların 412/7110’u sonrasında %5,8 saptandı. Geniş lokal reaksiyon ise olguların13’ünde %9,8 , tüm enjeksiyonların 41’i sonrasında %0,6 saptandı. Sistemik reaksiyonlar ise toplam 21 hastada %15.9 ,tüm enjeksiyonların ise 32’si sonrasında %0.4 ortaya çıkmıştır.Sonuç: Çocukluk yaş grubunda subkutan alerjen immünoterapisi uygulamalarında lokal, geniş lokal ve sistemik reaksiyonlar belirli bir oranda görülmektedir. İmmünoterapi tedavisinin başlanması, uygulamalarının yapılması ve izleminin deneyimli merkezler tarafından ve acil müdahalelerin yapılabileceği şartlarda uygulanması yerinde olacaktır
Anahtar Kelimeler
Kaynakça
- 1. Matsui EC, Eggleston PA. Immunotherapy for allergic disease. In: DYM Leung, HA Sampson, RS Geha, SJ Szefler (eds). Pediatric Allergy, Principles and Practise. St. Louis: Mosby; 2003. 277-85.
- 2. Nelson HS, Immunotherapy for inhalant allergens. In: Adkinson NF, Yunginger JW, Buse WW, Bochner BS, Holgate ST, Simons FER (eds). Middleton’s Allergy, Principles and Practice. 6th edition. Philadelphia: Mosby; 2003. 1455-73.
- 3. American Academy of Allergy, Asthma and Immunology. American College of Allergy, Asthma and Immunology . Allergen immunotherapy: A practice parameter. Ann Allergy Asthma Immunol 2003;90 (Suppl):1-40.
- 4. Bousquet J, Lockey R, Malling H-J, et al. Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol 1998;102: 558-62.
- 5. Abramson MJ, Puy RM, Weiner JM. Is allergen immunotherapy effective in asthma? A meta-analysis of randomized controlled trials. Am J Respir Crit Care Med 1995;151:969-74.
- 6. Ross RN, Nelson HS, Finegold I. Effectiveness of specific immunotherapy in the treatment of asthma: A meta-analysis of prospective, randomized, double-blind, placebo-controlled studies. Clin Ther 2000;22:329-41.;102:558-62.
- 7. Lockey RF, Benedict IM, Turkeltaub PC, et al. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1997;79: 660-677.
- 8 . Reid MJ, Lockey RF, Turkeltaub PC, Platts-Mills TA. Survey of fatalities from skin testing and immunotherapy 1985-1989. J Allergy Clin Immunol 1993;92:6-15.
- 9. Greenberg MA, Kaufman CR, Gonzalez GE, et al. Late and immediate systemic allergic reactions to inhalant allergen immunotherapy. J Allergy Clin Immunol 1986;77:865.
- 10. Li JT, Pearlman DS, Nicklas RA et al. Algorithm fort he diagnosis and management of asthma: A practice parameter update. Joint Task Force on Practise Parameters, representing the American Academy of Allergy, Asthma and Immunology, The American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998;81:415-20.
- 11. Gaglani B, Borish L, Bartelson BL ve ark. Nasal immunotherapy in weed-induced allergic rhinitis. Ann Allergy Asthma Immunol 1997;79:259-65.
- 12. Tinkelman DG, Cole WQ III, Tunno J. Immunotherapy: a one-year prospective study to evaluate risk factors of systemic reactions. J Allergy Clin Immunol 1995;95: 8-14.
- 13. Lim MS, Taner E, Lynn J, et al. Nonfatal systemic allergic reactions induced by skin testing and immunotherapy. Ann Allergy 1993;71:557-562.
- 14. Can D, Demir E, Tanaç R, Gülen F, Yenigün A. Immediate adverse reactions to immunotherapy. J ‹nvestig Allergol Clin Immunol 2003;13:177-180.
- 15. Nelson BL, Dupont LA, Reid MJ. Prospective survey of local and systemic reactions to immunotherapy with polen extracts. Ann Allergy 1986;56:331-34.
Öz
Aim: Local or fatal systemic reactions can be seen in allergen specific immunotherapy. This study was designed to investigate the possible reactions in subcutaneous conventional allergen specific immunotherapy in childhood. Materials and Methods: Subjects receiving immunotherapy for house dust mite-mix D.Pteronyssinus 50%, D.Farinae 50% or grasses-cereals pollens mix Grasses pollens 55%, Hordeum vulgare 10%, Avena sativa 10%, Secale cereale 15%, Triticum sativum 10% in Uludag University Medical Faculty, Pediatric Allergy Department from 1999 to 2007 were randomly recruited and retrospectively investigated. Local reactions were defined as edema and/or erythema of 2 to 5 cm at injection site, and edema and/or erythema greater than 5 cm were defined as large-local reactions. Systemic reactions were defined as the presence of at least one of the followings: urticaria, angioedema, bronchospasm, laringospasm and severe anaphylaxis. Results: During the study period, a total of 7110 injections were administered to 132 patients having asthma n=85 , allergic rhinitis or allergic rhinoconjunctivitis n=22 and asthma with allergic rhinitis or allergic rhinoconjunctivitis n=25 Sixty-eight patients had immunotherapy for mite-mix and 64 for grasses-cereals mix. Local reactions were detected in 35 patients 26,5% after 412/7110 injections 5.8% and large-local reactions in 13 9.8% patients after 41 injections 0.6% . Systemic reactions were detected in 21 15,9% patients, after 32 injections 0,4% . Conclusion: During the subcutaneous allergen specific immunotherapy in pediatric population side effects such as local, large-local and systemic reactions may occur to some extent. So, immunotherapy must be started, administered and followed-up only in specialized centers by specialized persons in optimal conditions where emergency intervention facilities are available. Journal of Current Pediatrics 2007; 5: 92-5
Anahtar Kelimeler
Kaynakça
- 1. Matsui EC, Eggleston PA. Immunotherapy for allergic disease. In: DYM Leung, HA Sampson, RS Geha, SJ Szefler (eds). Pediatric Allergy, Principles and Practise. St. Louis: Mosby; 2003. 277-85.
- 2. Nelson HS, Immunotherapy for inhalant allergens. In: Adkinson NF, Yunginger JW, Buse WW, Bochner BS, Holgate ST, Simons FER (eds). Middleton’s Allergy, Principles and Practice. 6th edition. Philadelphia: Mosby; 2003. 1455-73.
- 3. American Academy of Allergy, Asthma and Immunology. American College of Allergy, Asthma and Immunology . Allergen immunotherapy: A practice parameter. Ann Allergy Asthma Immunol 2003;90 (Suppl):1-40.
- 4. Bousquet J, Lockey R, Malling H-J, et al. Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol 1998;102: 558-62.
- 5. Abramson MJ, Puy RM, Weiner JM. Is allergen immunotherapy effective in asthma? A meta-analysis of randomized controlled trials. Am J Respir Crit Care Med 1995;151:969-74.
- 6. Ross RN, Nelson HS, Finegold I. Effectiveness of specific immunotherapy in the treatment of asthma: A meta-analysis of prospective, randomized, double-blind, placebo-controlled studies. Clin Ther 2000;22:329-41.;102:558-62.
- 7. Lockey RF, Benedict IM, Turkeltaub PC, et al. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1997;79: 660-677.
- 8 . Reid MJ, Lockey RF, Turkeltaub PC, Platts-Mills TA. Survey of fatalities from skin testing and immunotherapy 1985-1989. J Allergy Clin Immunol 1993;92:6-15.
- 9. Greenberg MA, Kaufman CR, Gonzalez GE, et al. Late and immediate systemic allergic reactions to inhalant allergen immunotherapy. J Allergy Clin Immunol 1986;77:865.
- 10. Li JT, Pearlman DS, Nicklas RA et al. Algorithm fort he diagnosis and management of asthma: A practice parameter update. Joint Task Force on Practise Parameters, representing the American Academy of Allergy, Asthma and Immunology, The American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 1998;81:415-20.
- 11. Gaglani B, Borish L, Bartelson BL ve ark. Nasal immunotherapy in weed-induced allergic rhinitis. Ann Allergy Asthma Immunol 1997;79:259-65.
- 12. Tinkelman DG, Cole WQ III, Tunno J. Immunotherapy: a one-year prospective study to evaluate risk factors of systemic reactions. J Allergy Clin Immunol 1995;95: 8-14.
- 13. Lim MS, Taner E, Lynn J, et al. Nonfatal systemic allergic reactions induced by skin testing and immunotherapy. Ann Allergy 1993;71:557-562.
- 14. Can D, Demir E, Tanaç R, Gülen F, Yenigün A. Immediate adverse reactions to immunotherapy. J ‹nvestig Allergol Clin Immunol 2003;13:177-180.
- 15. Nelson BL, Dupont LA, Reid MJ. Prospective survey of local and systemic reactions to immunotherapy with polen extracts. Ann Allergy 1986;56:331-34.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Aralık 2007 |
| Yayımlandığı Sayı | Yıl 2007 Cilt: 5 Sayı: 3 |