Characterizing Systemic Reactions During Subcutaneous Immunotherapy for House Dust Mite Allergies in China: Insights From a Cluster Analysis Study.

IF 4.3 2区医学 Q2 ALLERGY

Allergy, Asthma & Immunology Research Pub Date : 2025-09-01 DOI:10.4168/aair.2025.17.5.578

Qingxiu Xu, Jinling Liu, Xiang Dong, Lisha Li, Hao Chen, Yin Wang, Hongting Zhang, Juan Meng, Kai Guan, Pascal Demoly, Rongfei Zhu

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引用次数: 0

Abstract

Purpose: Subcutaneous immunotherapy (SCIT) can trigger systemic reactions (SRs) that pose potential life-threatening risks. To date, no cluster analysis has been conducted to delineate sub-phenotypes of SRs. This study aims to identify and characterize diverse SR phenotypes during SCIT for house dust mite (HDM) allergies in China.

Methods: This large retrospective real-world study enrolled patients diagnosed with HDM-sensitized allergic rhinitis (AR) and/or asthma who underwent SCIT (Alutard SQ; ALK) between February 2013 and July 2024 at five allergy centers in China. Data on demographic profiles and SRs were collected, followed by a cluster analysis among SR patients.

Results: A total of 3,126 patients received 107,588 injections, with SRs observed in 354 patients (11.32%) and 1,056 injections (0.98%). A higher incidence of SRs was noted in younger patients (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.88-0.92; P < 0.001), those with asthma (OR, 2.12; 95% CI, 1.69-2.66; P < 0.001), those with longer disease duration (OR, 1.08; 95% CI, 1.04-1.12; P < 0.001), those with high sensitization (OR, 3.84; 95% CI, 1.66-8.88; P = 0.002), and those with polysensitization (OR, 1.69; 95% CI, 1.30-2.20; P < 0.001). Four distinct clusters of SRs were identified: Cluster 1 (16.5%) primarily comprised relatively older females with lower specific immunoglobulin E (sIgE) levels, predominantly cutaneous involvement, fewer SRs overall but with grade 4 SR; Cluster 2 (29.9%) mainly included AR patients without asthma, mostly exhibiting grade 1 SR; Cluster 3 (34.0%) predominantly consisted of asthma patients with monosensitization, higher injection doses, and mostly grade 2 SR; Cluster 4 (19.6%) mainly featured younger males with higher sIgE levels, polysensitization, lower injection doses, the highest number of SRs, and more grade 3 SR.

Conclusions: Asthma, disease duration, high sensitization, and polysensitization emerge as independent risk factors for SRs. Our cluster analysis delineates distinct clinical phenotypes of SRs, offering tailored interventions for the personalized management of patients experiencing SRs.

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中国室内尘螨过敏皮下免疫治疗的全身反应特征：来自聚类分析研究的见解。

目的：皮下免疫治疗（SCIT）可引发系统性反应（SRs），构成潜在的危及生命的风险。到目前为止，还没有进行聚类分析来描述SRs的亚表型。本研究旨在鉴定和表征中国屋尘螨（HDM）过敏的SCIT过程中不同的SR表型。方法：这项大型回顾性现实世界研究纳入了2013年2月至2024年7月在中国五个过敏中心接受SCIT （Alutard SQ； ALK）治疗的诊断为hdm敏感性变应性鼻炎（AR）和/或哮喘的患者。收集人口统计资料和SR数据，然后对SR患者进行聚类分析。结果：3126例患者共接受107,588次注射，其中354例（11.32%）发生SRs， 1056例（0.98%）发生SRs。年轻患者（比值比[OR]， 0.90； 95%可信区间[CI]， 0.88-0.92; P < 0.001）、哮喘患者（OR, 2.12; 95% CI, 1.69-2.66; P < 0.001）、病程较长的患者（OR, 1.08; 95% CI, 1.04-1.12; P < 0.001）、高致敏性患者（OR, 3.84; 95% CI, 1.66-8.88; P = 0.002）和多致敏性患者（OR, 1.69; 95% CI, 1.30-2.20; P < 0.001）的SRs发生率较高。四种不同类型的SRs被确定：第一类（16.5%）主要由相对年长的女性组成，她们的特异性免疫球蛋白E （sIgE）水平较低，主要是皮肤受累，总体上SRs较少，但SR为4级；第2组（29.9%）主要为无哮喘的AR患者，多表现为1级SR；第3组（34.0%）主要为单致敏、注射剂量较高的哮喘患者，主要为2级SR；第4组（19.6%）主要为年轻男性，sIgE水平较高，多致敏，注射剂量较低，SRs数量最多，3级sr较多。结论：哮喘、病程、高致敏和多致敏是SRs的独立危险因素。我们的聚类分析描述了SRs的不同临床表型，为SRs患者的个性化管理提供了量身定制的干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Allergy, Asthma & Immunology Research ALLERGY-IMMUNOLOGY

CiteScore

6.10

自引率

6.80%

发文量

审稿时长

>12 weeks

期刊介绍： The journal features cutting-edge original research, brief communications, and state-of-the-art reviews in the specialties of allergy, asthma, and immunology, including clinical and experimental studies and instructive case reports. Contemporary reviews summarize information on topics for researchers and physicians in the fields of allergy and immunology. As of January 2017, AAIR do not accept case reports. However, if it is a clinically important case, authors can submit it in the form of letter to the Editor. Editorials and letters to the Editor explore controversial issues and encourage further discussion among physicians dealing with allergy, immunology, pediatric respirology, and related medical fields. AAIR also features topics in practice and management and recent advances in equipment and techniques for clinicians concerned with clinical manifestations of allergies and pediatric respiratory diseases.