| Allergic rhinitis(AR)is a frequently encountered otolaryngologic disease,with a continuously increasing morbidity rate in recent years.AR itself is not deadly, but it affects the patient’s life(includes sleeping, studying,working and entertainment) seriously,and also induce or complicated with diseases like bronchial asthma, sinusitis,nasal polyps and otitis media etc.Among its risk factors,bronchial asthma, medicine,food allergy,living environment and family history are closely related.AR has become a burning question around the whole world.The World Health Organization recommended treatment paradigm for AR mainly consists of four parts : 1.Avoid contact with allergens; 2.drug treatment; 3.The doctor-patient interaction and education;4.allergen-specific immunotherapy.In addition,treatment of AR can include surgical treatment,gene therapy, or traditional Chinese medicine.In the mainstream treatment paradigm,avoiding contact with the allergen is the obvious first-line intervention;the main purpose of the medication in the paradigm is to control symptoms,and doctor-patient interaction and education is important,but is only supplemental.In 2006,the European Academy of Allergology and Clinical Immunology noted that allergen-specific immunotherapy was a cause-targeted treatment that changed the development of the disease process,and should be used as soon as possible in order to prevent irreversible damage of the mucosa of the involved organ.Currently, allergen-specific immunotherapy for AR is categorized by treatment method,including subcutaneous immunotherapy(subcutaneous immunothempy,SCIT) and sublingual immunotherapy(sublingual immunothempy,SLIT). In order to improve the treatment of AR, the status of allergic rhinitis in Suzhou area were analyzed according to the data of skin prick test and SLIT in our hospital. This paper includes the following two parts:Part one:Complianceanalysis of sublingual immunotherapy;Part two:Evaluation of efficacy of sublingual immunotherapy of AR patients in Suzhou and the correlation between total nasal symptom score and visual analog scale.Part one Compliance analysis of sublingual immunotherapyObjective:To improve the compliance of SLIT through investigating the influence factors of refusing and giving up SLIT in patients with AR in Suzhou area.Methods:Investigate the influence factors of refusing SLIT in 2115 cases of AR patients suitable for SLIT after SPT.The data of 193 AR patients treated by sublingual immunotherapy(SLIT) were analyzed and the abscission rate was calculated to understand why a part of them could not insist on SLIT.Results:The main reasons that they refused SLIT were Long treatment period(42.5%), expensive cost(36.1%) and doubtful efficacy(14.7%).Among the 193 AR Patients who accepted SLIT,94 patients had been desquamated in 2 year and the abscission rate was 48.7%. 12 patients had been desquamated in 3 months,47 patients had been desquamated from 4 months to 6 months,22 patients had been desquamated from 7 months to 1 year,13 patients had been desquamated from 1 year to 2 years. The highest abscission rate was 26.0% during 4 months to 6 months and more than that during 1 to 3 months and that during 7 to 12 months, the differences were statistically significant(x2=27.419,4.104,respectively, P<0.05). Compare the desquamation rate during 7 months to 1 year with that during 1 year to 2 years, there was no statistical significance(x2=1.157,P﹥0.05).The desquamation rate in children(71.8%) was higher than that in adult(46.1 %), the differences were statistically significant(x2=8.221,P<0.05).The desquamation rate was 49.6%in men and 54.4%in women, there was no statistical significance(x2=0.408,P﹥0.05).Bad clinical effect, long treatment and symptom looking up were the main reasons of desquamation. Conclusion:The main reasons that they refused SLIT was long treatment period(42.5%),expensive cost(36.1%) and doubtful efficacy(14.7%).The most important period of the compliance descended was during 4 months to 6 months. The desquamation rate in children was higher than that in adult. Bad clinical effect, long treatment period and symptom looking up were the main reasons of desquamation. During SLIT, strengthening the health education of patients was needed to improvethe compliance.Part two Evaluation of efficacy of sublingual immunotherapy of AR patients in Suzhou and the correlation between total nasal symptom score and visual analog scale.Objective : To evaluate the efficacy of sublingual immunotherapy(SLIT) with standardized Dermatophagoides farinae drops in AR patients and the correlation between total nasal symptom score(TNSS) and visual analogue scale(VAS).Methods:The efficacy of SLIT in 99 patients who were sensitized to house dust mites and treated with Dermatophagoides farinae drops for 2 year with complete clinical data were studied. According to the results of SPT,the patients were divided into the monoallergen group and polyallergen group.According to the age,the patients were divided into the child group and the adult group. TNSS、Total-symptom VAS and the medication scores were recorded before and at six months, one year and two years during treatment and one year after cessation of the treatment. Then compare the treatment effects between groups and analyze the correlation between TNSS and Total-symptom VAS.Results:After SLIT for half a year, one year, and two years treatment, the symptoms in these patients were significantly improved compared with before. The TNSS were reduced from 7.00 [6.00;9.00]( the TNSS before SLIT) to 5.00 [4.00;7.00]、3.00 [1.00;4.00] and 3.00 [1.00;4.00]. The differences were statistically significant(Z value was-7.868 、-8.570and-8.570,respectively, P < 0.01).After SLIT for two years, the symptoms in these patients were improved compared after SLIT for one year, but there was no statistical significance(Z value was-1.732, P>0.05).There was no statistical significance(Z value was-1.941, P>0.05) between the group which after cessation of the SLIT for one year to the group which SLIT for two years. After SLIT for half a year, one year, two years treatment and one year after cessation of the treatment, the medication scores of these patients were significantly reduced compared with before. The differences were statistically significant(t value was11.609、20.223、21.310、20.736, respectively, P<0.01). In the course of two years,with the extension of treatment time, the medication scores decreased gradually, the differences were statistically significant(P<0.01). The medication scores of the group which after cessation of the SLIT for one year were increased than the group which SLIT for two years,but there was no statistical significance(t value was-1.750, P>0.05).After SLIT for half a year,one year and two years treatment, the symptoms in these patients of monoallergen group were significantly improved compared with before. The TNSS were reduced from 7.00[6.00;9.00](the TNSS before SLIT) to 5.00[4.00;6.00] 、2.50[1.00; 4.00] and 2.50[0.00; 4.00]. The differences were statistically significant(Z value was-6.729、-7.235、-7.235, respectively, P<0.01). After SLIT for half a year,one year, and two years treatment, the symptoms in these patients of polyallergen group were significantly improved compared with before. The TNSS were reduced from 7.00[6.00;9.00](the TNSS before SLIT) to6.00[4.00;7.00]、4.00[3.00;5.00]、4.00[3.00;5.00]. The differences were statistically significant(Z value was-3.322,-3.736 and-3.736, respectively, P<0.01).Before SLIT and after SLIT treatment for half a year,the TNSS in the monoallergen group was no significantly than that in the polyallergen group(Z value was-0.486 and-1.425,respectively, P >0.05),but after SLIT treatment for 1 year,2 years and one year after cessation of the treatment,there was significant difference between the two groups(Z value was-2.074,-2.118 and-2.543,respectively, P <0.05).Before SLIT, after SLIT for half a year,one year, two years treatment and one year after cessation of the treatment, the medication scores were no significant difference between the monoallergen sensitized group and polyallergen sensitized group(t value was0.858 、-1.009,-1.289,-1.466 and-1.496,respectively, P >0.05).After SLIT for half a year,one year, and two years treatment, the symptoms in these patients of child group were significantly improved compared with before. The TNSS were reduced from 7.50[7.00;9.00](the TNSS before SLIT) to 5.50[4.00;7.00],4.00[1.00; 5.00] and 4.00[0.00; 5.00].The differences were statistically significant(Z value was-4.137,-4.639 and-4.638, respectively, P<0.01). After SLIT for half a year,one year, and two years treatment, the symptoms in these patients of adultgroup were significantly improved compared with before. The TNSS were reduced from 7.00[5.00;9.00](the TNSS before SLIT) to 5.00[4.00;6.00],3.00[1.00;4.00] and 3.00[1.00; 4.00]. The differences were statistically significant(Z value was-6.729,-7.235 and-7.235, respectively, P<0.01).Before SLIT, after SLIT for half a year,one year, two years treatment and one year after cessation of the treatment, there was no significant difference between the child group and adult group(Z value was-1.917,-1.112,-1.023,-0.894 and-0.666,respectively, P >0.05). Before SLIT, after SLIT for half a year,one year, two years treatment and one year after cessation of the treatment, the medication scores were no significant difference between the child group and adult group(t value was0.682,0.661,0.353,0.101 and 0.118,respectively, P >0.05).Before SLIT, after SLIT for half a year,one year, two years treatment and one year after cessation of the treatment,TNSS correlated with VAS(Spearman coefficient of association was0.900,0.902,0.923,0.937 and 0.918,respectively, P <0.01).Conclusion:The dust mite drops can relieve symptoms after one year treatment,and a year after cessation of the treatment later can still maintain a good curative effect. SLIT with Dermatophagoides fariinae drops is effective in monosensitized and polysensitized patients with allergic rhinitis.The effection of monosensitized is better than polysensitized after 1~2years. TNSS correlated with VAS,when TNSS、VAS was used in assessing the disease severity and curative effect. |
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