舌下免疫治疗改善多重过敏与低龄过敏性鼻炎患儿症状及心理行为的临床证据

Clinical evidence of sublingual immunotherapy in improving symptoms and psycho-behavioral problems in children with multiple allergies and young-age allergic rhinitis

  • 摘要: 目的 探讨粉尘螨滴剂舌下免疫治疗对多重过敏与低年龄过敏性鼻炎(AR)患儿的临床疗效及心理行为的影响。方法 回顾性选取于南京医科大学第二附属医院就诊的139例螨虫致敏的AR患儿作为研究对象,根据过敏原种类将其分为单一过敏原组与多重过敏原组,根据年龄分为低年龄组(≤4岁)和高年龄组(>4岁)。比较治疗前,治疗后6、12个月患儿视觉模拟评分法(VAS)、鼻部总症状评分(TNSS)、儿童行为量表(CBCL)评分及血清总免疫球蛋白E(IgE)水平。结果 123例患儿完成为期1年的舌下免疫治疗和临床观察。与治疗前比较,经脱敏治疗6、12个月的患儿VAS评分、TNSS以及血清总IgE浓度均下降,且患儿治疗12个月的VAS评分、TNSS、血清总IgE浓度低于治疗6个月,差异有统计学意义(P < 0.05)。与治疗前比较,经脱敏治疗12个月后,患儿社交退缩、焦虑/抑郁、躯体诉述、多动项目评分降低,差异有统计学意义(P < 0.05)。脱敏治疗6、12个月后,多重过敏原组VAS评分、TNSS均低于单一过敏原组,差异有统计学意义(P < 0.05)。与治疗前相比,单一过敏原组和多重过敏原组治疗后6、12个月后血清总IgE浓度下降,差异有统计学意义(P < 0.05)。治疗前,高年龄组血清总IgE浓度高于低年龄组,差异有统计学意义(P < 0.05)。结论 舌下免疫治疗在多重过敏及低年龄(≤4岁)AR患儿中均能取得显著疗效,且对多重过敏患儿疗效更优。同时,该治疗还有利于减少儿童心理行为问题的发生,尤其可改善多动行为。

     

    Abstract: Objective To investigate the clinical efficacy and impact on psycho-behavioral aspects of sublingual immunotherapy with dermatophagoides farinae drops in children with multiple allergies and young-age allergic rhinitis (AR). Methods A total of 139 children with AR sensitized to mites who were treated at the Second Affiliated Hospital of Nanjing Medical University were retrospectively selected. Based on the types of allergens, they were divided into single-allergen group and multiple-allergen group, and into young-age group (≤4 years old) and older-age group (>4 years old) according to age. Visual Analogue Scale (VAS), Total Nasal Symptom Score (TNSS), Child Behavior Checklist (CBCL) score, and serum total immunoglobulin E (IgE) levels were compared before treatment and at 6 and 12 months after treatment. Results A total of 123 children completed one-year of sublingual immunotherapy and clinical observation. Compared with pre-treatment, the VAS scores, TNSS, and serum total IgE concentrations of children decreased at 6 and 12 months after desensitization treatment. Moreover, the VAS scores, TNSS, and serum total IgE concentrations at 12 months of treatment were lower than those at 6 months (P < 0.05). Compared with pre-treatment, after 12 months of desensitization treatment, the scores of social withdrawal, anxiety/depression, somatic complaints, and hyperactivity items in children decreased (P < 0.05). After 6 and 12 months of desensitization treatment, the VAS scores and TNSS in the multiple-allergen group were lower than those in the single-allergen group (P < 0.05). Compared with pre-treatment, the serum total IgE concentrations in both the single-allergen group and the multiple-allergen group decreased at 6 and 12 months after treatment, with statistically significant differences (P < 0.05). Before treatment, the serum total IgE concentration in the older-age group was higher than that in the young-age group (P < 0.05). Conclusion Sublingual immunotherapy can achieve significant efficacy in children with multiple allergies and young-age (≤4 years old) AR, and shows better efficacy in children with multiple allergies. Meanwhile, this treatment is also beneficial for reducing the occurrence of psycho-behavioral problems in children, especially for improving hyperactive behavior.

     

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