Reimers A R, Weber M, Müller U R
Medical Division, Zieglerspital Bern, Switzerland.
Clin Exp Allergy. 2000 Feb;30(2):276-82. doi: 10.1046/j.1365-2222.2000.00697.x.
Bites by poisonous European snakes of the genus Vipera lead to local tissue damage and systemic symptoms such as generalized oedema, hypotension, gastrointestinal symptoms, haemolysis and renal dysfunction. Not rarely anaphylactic symptoms like urticaria, localized angioedema and asthma are observed.
To look for snake venom-specific immunoglobulin (Ig) E antibodies in patients with a history of bites by European vipers and for cross-reactions with Hymenoptera venoms, that have a similar composition.
Ten patients with a history of bites by Vipera aspis or Vipera berus were investigated. Three patients had been bitten only once, and two of these had developed only local reactions. Four reported previous allergic reactions to Hymenoptera stings. All patients, 10 Hymenoptera venom-allergic and five nonallergic individuals who served as controls underwent i.c. skin test endpoint titration with snake (V. aspis, V. berus) and Hymenoptera venoms (honey bee, Vespula spp.) and were investigated for specific serum IgE antibodies to the same venoms.
Seven of the eight patients with systemic snake bite reactions had both positive skin tests and serum IgE antibodies to snake venoms, while these tests were negative in the two patients with only local reactions to snake bites and all controls. Seven of the eight patients with systemic snake bite reaction also had positive skin tests and specific IgE with one or both Hymenoptera venoms. By RAST-inhibition with sera of four patients with high IgE to both Vipera and Hymenoptera venoms, partial cross-reactivity could be demonstrated in one.
Anaphylactic reactions following snake bites may be IgE-mediated, especially in patients with repeated bites.
欧洲蝰蛇属毒蛇咬伤可导致局部组织损伤和全身症状，如全身性水肿、低血压、胃肠道症状、溶血及肾功能障碍。荨麻疹、局限性血管性水肿和哮喘等过敏症状也并不罕见。
在有欧洲蝰蛇咬伤史的患者中寻找蛇毒特异性免疫球蛋白（Ig）E抗体，并探寻其与成分相似的膜翅目毒液的交叉反应。
对10例有极北蝰或矛头蝮咬伤史的患者进行调查。3例患者仅被咬伤过1次，其中2例仅出现局部反应。4例报告既往对膜翅目昆虫叮咬有过敏反应。所有患者、10例对膜翅目毒液过敏及5例作为对照的非过敏个体均接受了用蛇毒（矛头蝮、极北蝰）和膜翅目毒液（蜜蜂、黄蜂属）进行的皮内试验终点滴定，并检测了针对相同毒液的特异性血清IgE抗体。
8例有全身性蛇咬伤反应的患者中，7例皮试阳性且血清中有针对蛇毒的IgE抗体，而2例仅对蛇咬伤有局部反应的患者及所有对照的这些检测均为阴性。8例有全身性蛇咬伤反应的患者中，7例对一种或两种膜翅目毒液的皮试也呈阳性且有特异性IgE。通过对4例对蝰蛇和膜翅目毒液均有高IgE水平的患者血清进行放射变应原吸附试验抑制，可在1例中证实部分交叉反应。
蛇咬伤后的过敏反应可能由IgE介导，尤其是在多次被咬的患者中。
