通年性アレルギー性鼻炎に対する免疫療法 長期施行例に対する臨床効果

Abstract

Immunotherapy has been widely used to treat allergic respiratory disorders and has been shown to be effective in the treatment of respiratory allergy, in particular allergic rhinitis. Improvement usually occurs in approximately 80 percent of patients with perennial rhinitis during the course of immunotherapy. The purpose of this paper is to elucidate the clinical outcome of immunotherapy for perennial rhinitis, with special emphasis on the clinical improvement of long-term immunotherapy. This study included 77 patients with perennial rhinitis due to house dust mite, Dermatophagoides farinae (D. farinae), treated with long-term immunotherapy (more than 36 months: 3 to 18 years) with D. farinae extracts.The following results were obtained from answers to questionnaire, a survey of clinical records, and patients'daily recordings of nasal symptoms.1. Relief (excellent and moderate improvement) from sneezing attacks, watery hypersecretion, and nasal congestion was noted in 87%, 93.5%, and 84.4%, respectively.2. In the majority of the patients alleviation of sneezing attacks and watery hypersecretion occurred during the early phase of treatment. On the other hand, in the vast majority relief from nasal congestion was not achieved during the first year of treatment.3. Relief from nasal symptoms increased continuously in over 80% of the patients even after 2 years as immunotherapy proceeded, and sustained clinical relief from nasal congestion persisted even 2 years after the course of treatment.4. Moderate or more general improvement was obtained in 88.3% of the patients as judged by the Okuda's criteria, and 84.4% of the patients stated that they were significantly satisfied with longterm immunotherapy. How much each patient was satisfied with immunotherapy depended significantly upon how much his nasal obstruction was improved.5. Of the 77 patients studied, two had severe systemic reactions (anaphylaxis) at some time during the immunotherapy.Evidence from our clinical study supports the conclusion that immunotherapy is not without risk but is very effective in perennial rhinitis and that the control of nasal congestion in the early phase of treatment is a key to successful immunotherapy.