Lockey R F, Nicoara-Kasti G L, Theodoropoulos D S, Bukantz S C
Department of Internal Medicine, University of South Florida College of Medicine, and James A. Haley Veterans' Medical Center, Tampa 33612, USA.
Ann Allergy Asthma Immunol. 2001 Jul;87(1 Suppl 1):47-55. doi: 10.1016/s1081-1206(10)62195-3.
The primary objective of this review is to discuss systemic allergic reactions and risk factors associated with the injection of allergen vaccines.
A review of the literature on anaphylactic reaction, adverse effects, and fatalities associated with allergen immunotherapy (IT) was conducted.
The expert opinion of the author was used to select relevant data.
Systemic allergic reactions associated with the injection of allergen vaccines usually begin within 20 minutes. However, on occasion, they begin 20 to 30 minutes or longer after an injection. Such reactions can also occur after allergen skin testing. Most reactions associated with skin testing and allergen IT are mild and readily respond to appropriate treatment. However, severe and even fatal reactions have been reported with both skin testing and IT.
Risk factors for skin testing and allergen IT include: 1) patients, particularly asthmatic patients, suffering with seasonal exacerbation of their symptoms; 2) patients who demonstrate exquisite sensitivity to particular allergen(s); 3) patients on beta-blockers; 4) patients with asthma, especially if their asthma is unstable; 5) patients in whom rush IT is used; and 6) patients in whom high doses of potent standardized allergen vaccines are used. It is essential that strict attention be paid to the risk factors for systemic reactions, and that techniques and management be initiated both before and after skin testing or IT to minimize these risks. Done properly, the risk of skin testing and IT is minimal.
本综述的主要目的是探讨与注射变应原疫苗相关的全身性过敏反应及危险因素。
对有关变应原免疫疗法（IT）相关的过敏反应、不良反应及死亡情况的文献进行了综述。
作者的专家意见被用于选择相关数据。
与注射变应原疫苗相关的全身性过敏反应通常在20分钟内开始。然而，偶尔也会在注射后20至30分钟或更长时间开始。此类反应也可在变应原皮肤试验后发生。大多数与皮肤试验和变应原IT相关的反应较轻，对适当治疗反应良好。然而，皮肤试验和IT均报告过严重甚至致命的反应。
皮肤试验和变应原IT的危险因素包括：1）患者，尤其是症状有季节性加重的哮喘患者；2）对特定变应原表现出极度敏感的患者；3）服用β受体阻滞剂的患者；4）哮喘患者，尤其是哮喘病情不稳定者；5）采用快速IT的患者；6）使用高剂量强效标准化变应原疫苗的患者。必须严格关注全身性反应的危险因素，并在皮肤试验或IT前后启动相关技术和管理措施以将这些风险降至最低。操作得当，皮肤试验和IT的风险极小。
