Lin R Y, Trivino M R, Curry A, Pesola G R, Knight R J, Lee H S, Bakalchuk L, Tenenbaum C, Westfal R E
Department of Medicine, Saint Vincents Hospital & Medical Center of New York-New York Medical College, New York 10011, USA.
Ann Allergy Asthma Immunol. 2001 Nov;87(5):412-6. doi: 10.1016/S1081-1206(10)62923-7.
Elevations of interleukin 6 (IL-6) have been described in drug-induced anaphylaxis. Although IL-6 is well known to stimulate an acute phase response, profiling acute phase protein levels, such as C-reactive protein (CRP), has, to our knowledge, never been performed in patients with acute allergic reactions.
To examine the pattern of IL-6 and CRP levels in patients with acute allergic reactions and to relate these to relevant clinical and laboratory parameters.
Plasma CRP and serum IL-6 levels were determined in 85 adult emergency department patients. These patients had been previously studied with questionnaires, physical examinations, and histamine/tryptase levels. Clinical and historical features were related to CRP and IL-6 levels. CRP and IL-6 levels were also examined for relationships with histamine and tryptase levels.
CRP and IL-6 levels were significantly correlated with one another in the study patients (Spearman p = 0.36, P = 0.0008). Similar to histamine levels, IL-6 levels were significantly correlated with the extent of erythema manifested by the study patients. The extent of erythema was independently predicted by both IL-6 and histamine levels. Histamine levels were negatively correlated with CRP levels (Spearman p = -0.32, P = 0.003). Unlike histamine levels, IL-6 and CRP did not show significant relationships with the extent or presence of urticaria/angioedema or the presence of wheezing. IL-6 levels were correlated with the duration of symptoms before serologic sampling. An inverse correlation was observed between IL-6 levels and mean arterial blood pressure. Multivariate modeling showed significant independent effects from mean arterial pressure, duration of symptoms, erythema extent, and age in predicting IL-6 levels. Tryptase levels were higher in patients whose IL-6 levels were >20 pg/mL.
CRP and IL-6 levels are not simple surrogate markers for histamine or tryptase release by mast cells or basophils in acute allergic reactions. Increasing IL-6 levels relate to greater erythema extent, lower mean arterial blood pressure, and a longer duration of symptoms. It would be interesting to speculate that CRP and IL-6 increases characterize a late-phase response in immediate hypersensitivity reactions. In this perspective, the inverse relationship between CRP and histamine levels could be explained. As histamine levels are waning, CRP levels are increasing. Timed studies for histamine and CRP/IL-6 levels in allergic reactions are necessary to confirm this hypothesis.
白细胞介素6（IL-6）升高在药物性过敏反应中已有报道。尽管众所周知IL-6会刺激急性期反应，但据我们所知，从未对急性过敏反应患者的急性期蛋白水平（如C反应蛋白（CRP））进行分析。
研究急性过敏反应患者的IL-6和CRP水平模式，并将其与相关临床和实验室参数相关联。
测定了85例成年急诊科患者的血浆CRP和血清IL-6水平。这些患者之前已通过问卷调查、体格检查以及组胺/类胰蛋白酶水平进行过研究。临床和病史特征与CRP和IL-6水平相关。还研究了CRP和IL-6水平与组胺和类胰蛋白酶水平的关系。
在研究患者中，CRP和IL-6水平显著相关（Spearman p = 0.36，P = 0.0008）。与组胺水平相似，IL-6水平与研究患者的红斑程度显著相关。红斑程度可由IL-6和组胺水平独立预测。组胺水平与CRP水平呈负相关（Spearman p = -0.32，P = 0.003）。与组胺水平不同，IL-6和CRP与荨麻疹/血管性水肿的程度或存在与否以及喘息的存在与否均无显著关系。IL-6水平与血清学采样前症状持续时间相关。观察到IL-6水平与平均动脉血压呈负相关。多变量建模显示，平均动脉血压、症状持续时间、红斑程度和年龄在预测IL-6水平方面具有显著独立效应。IL-6水平>20 pg/mL的患者类胰蛋白酶水平更高。
在急性过敏反应中，CRP和IL-6水平并非肥大细胞或嗜碱性粒细胞释放组胺或类胰蛋白酶的简单替代标志物。IL-6水平升高与更大的红斑程度、更低的平均动脉血压以及更长的症状持续时间相关。推测CRP和IL-6升高是速发型超敏反应晚期反应的特征，这将很有意思。从这个角度来看，CRP与组胺水平之间的负相关关系可以得到解释。随着组胺水平下降，CRP水平上升。对过敏反应中的组胺和CRP/IL-6水平进行定时研究对于证实这一假设是必要的。
