摘 要
免疫治療是藉由反覆投與過敏原萃取物來減緩或消除第一型過敏反應所造成的症狀。皮下免疫治療或舌 下免疫治療都是透過改變T 細胞和抗體的反應來產生療效。免疫治療可用於改善昆蟲叮咬產生的嚴重過敏性反 應、過敏性鼻炎、氣喘及吸入性過敏原引起的異位性皮膚炎。免疫治療有機會改變兒童過敏性疾病的自然病程，
避免成長過程產生新的過敏原，或減少由過敏性鼻炎進展至氣喘的機率，免疫治療另一個特點是經過3-5 年的 治療，停止治療後療效仍可以維持多年。進行免疫治療時要小心可能產生的全身性反應，慎選病人才能發揮其 療效。
Key words: allergy, asthma, immunotherapy, rhinitis, subcutaneous, sublingual（過敏，氣喘，免疫治療，鼻炎，皮下，
舌下）
台中榮民總醫院 耳鼻喉部
通訊作者及抽印本索取處：梁凱莉 40705 台中市台灣大道四段 1650 號 台中榮民總醫院耳鼻喉部 聯絡電話：(04) 23592525 轉 5405
皮下免疫治療的效果來自改變過敏患者體內抗 及黏膜表面的介白素10 號 (interleukin-10, IL-10) 及 TGF-β 升高，介白素 10 號由 T 調節細胞 (regulatory T cell, Treg) 所製造，可抑制巨細胞 (mast cell)、嗜 酸性球(eosinophil) 的作用，並影響 B 細胞使其產生 IgG417。舌下免疫治療的機轉認為是抗原由舌下黏膜 內的樹狀細胞(dendritic cell) 攜帶至鄰近的淋巴結呈 現給T 細胞，促使原型的 T 細胞轉化為第一型助手 作的全面性回顧研究(systemic reviews)，回顧的文獻 包含以此治療塵蟎、花粉、寵物及黴菌，結論是免疫 合免疫吸附分析(enzyme-linked immunosorbent assay, ELISA)、 放 射 過 敏 原 吸 附 試 驗 (radioallergosorbent 嚴重過敏反應。維持期(maintenance phase) 的治療為 每4-6 週注射一次，維持注射三年或更久。如開始維
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圖一、免疫治療的機轉
梁凱莉 江榮山