집먼지진드기에 대한 설하면역치료 초기 단계에서 발생한 아나필락시스 1례
A Case of Anaphylaxis after the First Dose of Sublingual Immunotherapy with House Dust Mite
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초록
SLIT은 SCIT에 비해 비교적 안전하다고 알려져 있으며, 부작용은 용량을 증가시키는 단계에서 주로 보고되었다. 저자들은 집먼지진드기에 대한 SLIT 초기 치료 시작 시 아나필락시스를 일으킨 환자를 경험하였기에 보고하는 바이며, 첫 번째 투여는 병원에서 하는 것이 바람직하며 주의 깊은 관찰이 필요하겠다.
Abstract
The advantages of sublingual immunotherapy (SLIT) are its friendly route of administration and less frequent occurrence of severe side-effects. The most frequently reported events were irritation of the throat and oral itching. According to the recent data, the number of side effects seems to be dose-dependent. We report on one case of anaphylaxis after the first dose of SLIT with house dust mite drop. A 10-year-old girl suffered from severe allergic rhinitis with perennial symptoms and asthma for which a low dose inhaled corticosteroid was used. Her allergy workup disclosed a positive skin prick test to Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, hazel tree, alder, dog, cat, platane, and acacia pollens. We started SLIT (Pangramin SLIT, ALK- Abello, Madrid, Spain) with D. pteronyssinus and D. farinae. Fifteen minutes after the first dose taken at home, she experienced local irritation, lip swelling, facial rash, rhinorrhea and cough. Provocation test was performed in the clinic with the same drug (0.00015 µg/drop, 1.6 STU/mL of D. pteronyssinus and D. farinae, respectively). After twenty minutes, she reported lip swelling, perioral wheals, rash and cough. Wheezing was aggravated, and peak expiratory flow rate (PEFR) dropped by 13% compared to prechallenge PEFR. We stress to have the first dose of SLIT taken in the clinic with an observation period.
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