目的 探讨在免疫治疗前识别尘螨皮下免疫治疗相关全身不良反应（systemic adverse reactions，SARs）的高危患儿。 方法 对发生SARs的患者在免疫治疗启动前的高危因素进行了分析。选择自2021年4月至2025年1月接受屋尘螨变应原制剂治疗的尘螨过敏性鼻炎患儿当中发生SARs的患儿40例为观察组，以没有发生SARs的患儿54例作为对照组。分析两组性别、年龄、病程、酸性粒细胞数、多重致敏、多系统损害，总IgE（tIgE）、尘螨特异性IgE（sIgE）等方面的差异。 结果 观察组及对照组在多重致敏、多系统损害，tIgE水平等方面存在显著差别，两组多重致敏的比率分别为70.0%、48.1%（P = 0.034），多系统损害的比率分别为55.0%、22.2%（P = 0.001），高水平tIgE（tIgE ≥ 327.8 IU/mL）比率分别为82.5%、62.1%（P = 0.025）。多因素Logistic回归分析显示多系统损害［OR = 4.278，95%CI： 1.749 ~ 10.461）］是变应原免疫治疗（allergen immunotherapy，AIT）发生SARs的独立危险因素。 结论 伴有多系统损害尘螨过敏性鼻炎的患儿，做AIT时，常规预防SARs的效果较差，他们很可能仍会发生SARs，需要更强的预防SARs的措施，从而提高AIT的安全性。

Objective To identify children with high-risk systemic adverse reactions （SARs） associated with dust mite subcutaneous immunotherapy prior to immunotherapy. Methods An analysis was conducted on the high-risk factors in patients who experienced SARs prior to initial immunotherapy. A total of 40 pediatric patients with dust mite allergic rhinitis who underwent treatment with Dermatophagoides pteronyssinus （Dp） extracts at our hospital's pediatric department from April 2021 to January 2025 and developed SARs were selected as the observation group， while 54 patients who did not experience SARs served as the control group. Differences in gender， age， disease duration， eosinophil count， polysensitization， multisystem involvement， total IgE （tIgE）， and dust mite-specific IgE （sIgE） were evaluated. Results Significant differences were observed between the observation and control groups in polysensitization， multisystem involvement， and tIgE levels. The polysensitization rates were 70% vs. 48.1% （P = 0.034）， multisystem involvement 55% vs. 22.2% （P = 0.001）， and high tIgE levels （tIgE ≥ 327.8 IU/mL） 82.5% vs. 62.1% （P = 0.025）. Multivariate logistic regression identified multisystem involvement ［OR（95% CI） = 4.278 （1.749 ~ 10.461）］ as an independent risk factor for SARs during allergen immunotherapy （AIT）. Conclusion Patients with dust mite allergic rhinitis accompanied by multi-system damage exhibit poorer conventional prevention efficacy against SARs when undergoing AIT. They remain highly susceptible to SARs occurrence， necessitating more robust preventive measures against SARs to enhance the safety of AIT.