422 :1000-7423(2008)-06-0422-06, (SIT) 1998-2005 (Df) (SPT) SPT ++ 3 : A, 1 100 000 (w/v) 0.3 0.6 1.0 ml, 1 / 3, 1 10 000 1 5 000 (w/v), 9 ; 1 5 000 (w/v) 1.0 ml/( ) 6, B, 3 1 d, 3 30 min, 3 d; 1 5 000 (w/v) 1.0 ml/( d) 6 d, A B 1 1 5 000 (w/v) 1.0 ml 2 1, 1 C,, 10 mg/d+ 10 mg/d, 7 d 1 ( ) ELISA 20 IgE (tige) IgE (sige) 2 685, 70.3% (1754/2 496), 63.5% (54/85) 60.6% (63/104)(P<0.05) 248 SPT ++, 1 91.1% (226/248), 66.1% (164/248), [12.7% (20/158)](P<0.01);, ( + 76.7%>55.0%)(P<0.05) 20 tige 1, sige (P<0.01),, : R757.3 : A 1, 2, 3, 3, 4, 4 Urticaria in Relation to Mite Sensitivity and Immunotherapy with Injectio dermatophagoidei farinae XING Dao-rong 1, WEN Ting-huan 2, YU Yang-lin 3, WEI Zhi-ping 3, LI Yi-ming 4, HAN Tian 4 ( 1 Department of Pathogen Biology, Xuzhou Medical College, Xuzhou 221002, China; 2 Medical Acarology Laboratory, Shanghai Medical College, Fudan University, Shanghai 200032, China; 3 Department of Dermatology, Xuzhou Medical College Affiliated Hospital, Xuzhou 221006, China; 4 Parasitology Team, Xuzhou Medical College, Xuzhou 221002, China) Abstract Objective To investigate the prevalence of mite sensitivity in patients with urticaria or other skin rashes, and to observe the clinical efficacy of a specific immunotherapy (SIT) by the Injectio dermatophagoidei farinae for the patients. Methods In 7-year period (1998-2005), skin prick test (SPT) with a dust mite (Df) allergen was carried out to detect the prevalence of mite sensitivity in OPD patients suffering from skin rashes. Among the patients sensitive to mite with SPT ++ response, 3 groups were established. In group A, routine SIT with Injectio dermatophagoidei farinae was conducted. In 9-week increasing dose phase, three stepwise increasing volumes (0.3ml, 0.6 ml and 1.0 ml) each case was injected subcutaneously with mite concentration of 1 100 000 (w/v), 1 10 000 (w/v) or 1 5 000 (w/v) respectively once a week, followed by a maintenance dose phase for an injection with 1 5 000 (w/v) 1.0 ml/wk for 6 weeks. Group B received rush SIT with mite injections. A total of 15 injections in a course of therapy with same concentration and volume was given as those for the routine ones except shortened intervals, namely, 9 initial injections completed in 3 days by three injections of each concentration per day with two 30 min intervals, maintenance : 1, 221002; 2, 200032; 3, 221006; 4, 221002
423 doses were then provided in 6 days with 1 5 000 (w/v) 1.0 ml/d. Thereafter, both groups A and B were maintained for one year with a dose of 1 5 000 (w/v) 1.0 ml every 2 wk. Group C received antihistamine treatment as control, the patients received daily oral Ebastine 10 mg in the morning and Cetirizine dihydrochloride 10 mg in the evening for one week course and pro re nata later. Levels of serum tige and serum mite sige were detected by ELISA in 20 urticaria cases before and after one year mite SIT. Results Altogether, 2 685 cases with skin rashes were detected by Df allergen SPT. The prevalence of urticaria cases sensitive to mite was 70.3% (1 754/2 496), which was higher than that of eczema 63.5% ( 54/85) and anaphylactoid purpura 60.6% ( 63/104) (P <0.05). 248 cases of urticaria sensitive to mite with SPT ++ response received SIT with Injectio dermatophagoidei farinae for one year, clinical evaluation revealed an overall efficacy of 91.1% (226/248) with 66.1% (164/248) of excellent or good results, significantly higher than that of antihistamine treatment [12.7% (20/158)] (P<0.01). Faster improvement of clinical symptoms was shown in rush SIT ( group B) than that of routine one ( group A), with higher efficacy in group B than group A ( excellent and good results being 76.7% and 55.0% respectively)(p<0.05). Serum tige and mite sige in 20 urticaria cases were detected before and after one year mite SIT, showing that tige decreased by half in 40% (8) of the patients, while serum mite sige level increased significantly ( P <0.01) one year later. Conclusion Mite allergen SPT is an etiological diagnostic technique for urticaria patients sensitive to mite. Clinical efficacy of mite allergen SIT has been proved to be good for the patients, and the rush SIT shows quicker effect of relieving symptoms and better efficacy than that of the routine immunotherapy. Key words Urticaria Mite sensitivity Allergen Skin prick test Injectio Dermatophagoidei farinae Specific immunotherapy Antihistamine treatment, 1 100 (w/v, 1 g 100,, ml, )( SMU ALG 1101.,, 80%~90% 980328) ( SMU, ALG 01.980108) ( [1],, SMU ALG 02.980208) ( /, SMU P.971218) IgE (tige)elisa ; [2] ( SMU tige ELISA K980808) [3] 71.1%, IgE ( sige) ELISA ( SMU Df sige 515, ELISA K980818) 82.3%,, (1998-2001 ) (specific immunotherapy, SIT) (2001-2005 ) (Ebastine, H2- [4], 0040119), 1998-2005 (Cetirizine dihydrochloride, (Dermatophagoides farinae, Df) (skin prick test, SPT) ( ), 3 (SPT) (SPT ++) [5],, 3, >3 cm, 1, 1 1998-2005 8~10 min,,,, ; 15~20 min, 2 H20020290),, 2~3 min (histamine equivalent prick,hep), (-)
424, < ), 1/4; (+ ) 1/4, (50 25 12.5 6.26 3.125 IU/ml) (++) 1/2, (+++) 0.1 ml IgE, 1 h, (++++) 2, ( IgE), 4 4.1 ) (A 450 ), SPT ++, 3, A, tige 300 IU/ml ; sige A 450 1 100 000 (w/v) 0.3 0.6 1.0 ml, 1 / 3 [6] 4, 0( ) <0.35,, 1 10 000 1 5 000 (w/v), ( ) 0.35, ( ) 0.70, ( ) 3.50 9 ; 1 5 000 (w/v) 1.0 ml/( ) 6, B 6, 3 1 d, 3 30 min, 3 d; 1 5 000 (w/v) 1.0 ml/( d) 6 d, A B 1 1 5 000 (w/v) 1.0 ml 2 1, 1 C,,, IgE Wilcoxon 10 mg/d ( ) 10 mg/d ( ), 7 d 1,, 1 4.2, ),, 6,, 70.3% (1 754/2 496) 63.5% 4 : 1 : (54/85) 60.6% (63/104), 6 ; 2 :,, ; 3 : (P<0.05) 69.5%,, ; 4 : 68.1%, (P>0.05)( 1) 5 IgE 18~34, 10 (184/238) 76.1%(51/67),, SPT ++, (P<0.01) 1 68.9% (1 014/1 472) 72.3%, 2 ml,, ELISA IgE (tige) (Df) ( 2) IgE (sige) ( sige 1 h,, (OPD), (DG3022, SPSS13.0,, 3 2 685 (,, 41~50 >61, 77.3% (740/1 024 ), (P >0.05) Table 1 1 SPT Incidence of mite-sensitivity of patients with skin rashes detected by Df allergen SPT Skin rash Urticaria Eczema Anaph. purpura Total Female Male Subtotal 1 472 42 60 1 574 1 014 24 34 1 072 68.9 57.1 56.7 68.1 1 024 43 44 1 111 740 30 29 799 72.3 69.8 65.9 69.5 2 496 85 104 2 685 1 754 54 63 1 871 70.3 * 63.5 60.6 69.7 : *, P<0.05 Note: * That of urticaria vs. other skin rashes, P<0.05.
425 Table 2 2 SPT Mite sensitivity of urticaria patients responding to Df allergen SPT by age Age 0~ 11~ 21~ 31~ 41~ 51~ 61~ Total Female 146 97 287 194 393 270 368 257 166 120 75 49 37 27 1 472 1 014 66.4 67.6 68.7 69.8 72.3 65.3 73.0 68.9 196 264 218 205 72 39 30 1 024 Male 124 63.3 191 72.6 164 75.2 152 74.2 64 88.9 21 53.9 24 80.0 740 72.3 Subtotal 342 551 611 573 238 114 67 2 496 221 385 434 409 184 70 51 1 754 64.6 69.0 71.0 71.4 77.3 * 61.4 76.1 * 70.3 : * 41~50 >61, P<0.05 Note: * 41-50 year and 61 year groups vs. other groups, P<0.05. 2 SPT (+++) (++++) 426, 4 3 24.3% (426/1 754) Table 4 Efficacy comparison between three formulae SPT (, P>0.05), of treatment for urticaria 3 SPT Table 3 SPT reactivity of urticaria patients to Df allergen by age Age 0~ 11~ 21~ 31~ 41~ 51~ 61~ Total 1 754 SPT +~++++ 47.1% 28.6% 13.1% 11.2%,, 40 SPT,, 50 ( 3) +(%) 116(52.5) 183(47.5) 195(44.9) 170(41.6) 97(52.7) 38(54.3) 27(52.9) 826(47.1) Df SPT SPT reactivity to Df allergen ++(%) 56(25.3) 95(24.7) 131(30.2) 138(33.7) 49(26.3) 20(28.6) 13(25.5) 502(28.6) +++(%) 30(13.6) 57(14.8) 50(11.5) 52(12.7) 25(13.6) 10(14.3) 5(9.8) 229(13.1) ++++(%) 19(8.6) 50(13.0) 58(13.4) 49(12.0) 13(7.1) 2(2.9) 6(11.8) 197(11.3) Subtotal 221 385 434 409 184 70 51 1 754 Efficacy Group No. cases Excellent Good No. (%) No. (%) 120 34(28.3) Routine immunotherapy 128 50(39.1) Rush immunotherapy Subtotal 248 84(33.8) of mmunotherapy Antihistamine 158 0 0 treatment Fair No. (%) 32(26.7) 32(26.7) 48(37.5) 30(23.4) 80(32.3) 62(25.0) 20(12.7) No effect No. (%) 22(18.3) * 0(0) 22(8.9) ** 138(87.3) : *, Ρ<0.05; **, Ρ<0.05 Note: * Vs rush immunotherapy group, Ρ<0.05; **Vs antihistamine treatment group, Ρ<0.05. 3 (14 d), (9 d) (2 3.1 248 ),, 6 SPT ++ 12.7%, 120, 98,,, 2, 81.7%; 128, 100% (Ρ<0.05), 91.1% (226/248), 3.3 248 84, 80, 66.1% (164/248) 158, 20 (, (Ρ<0.05)( 4) 3.2 1 2, 4, 5 [1 5 000 (w/v)] [1.0 12.7%), ml], 10 min,, 138 ( 87.3%),
426 4 tige 4.2 Df sige ELISA, 4.1 tige ELISA, 20 Df sige A 450 tige 300 IU/ml ( 3.50) 2 (10%) ( 0.70) 8 19, 8 (40%) 2 000 IU/ml, 6 1 000 (40%) ( 0.35) 3 (15%) 0 (<0.35) IU/ml (30%), 5 (25%) 1 000~2 000 IU/ml, 1 7 (35%) Df sige tige,, (P<0.01) 16 (P<0.01) 8 (40%) 1/2 ( 5) (80%), 4 Df sige, 10 1, 6 2 ( 5) Table 5 5 tige sige Serum tige and Df sige levels in urticaria patients before and after Df SIT Case 1 2 3 4 5 6 7 8 9 10 tige (IU/ml) Df sige (A 450nm) tige (IU/ml) Df sige (A 450nm) Case Before SIT After SIT Before SIT After SIT Before SIT After SIT Before SIT After SIT 1 200 1 056 320 984 1 080 1 632 1 080 2 040 7 22.9 480 151 0.18 3.96 3.00 0.43 2.18 1.14 3.00 3.29 0.04 0.29 0 9.43 10.00 16.33 10.00 2.00 6.90 7.67 1.50 0.67 11 12 13 14 15 16 17 18 19 20 480 984 624 840 1 224 1 008 1 200 150 2 064 528 192 723 151 480 1 176 984 192 150 300 0.39 0.68 3.61 0.11 2.68 0.18 3.29 3.00 0.04 0.29 11.67 0.83 3.83 2.00 15.67 2.30 5.00 4.20 0.83 0.83,,,, IgG1 IgG4 2,,, IgE 0.5%,,,, 1, H1,,, [7],,,, [10], 70.3% IgE [2], 20 tige, 19, 2001 10, 1, tige,, 80% sige, ( ), 1,,, 1,,, [8] WHO,,,,,,,, TH1/TH2, WHO, 7 d T,, ; [8],,,,,, [9],,
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