Luskin Allan T., Luskin Susan S.
Department of Immunology/Microbiology, Rush Medical Center, Madison, WI, and Respiratory Center, Dean Medical Center, Madison, WI.
Am J Ther. 1996 Jul;3(7):515-520. doi: 10.1097/00045391-199607000-00007.
Anaphylaxis is an acute fatal or potentially fatal hypersensitivity reaction. Anaphylaxis represent a clinical diagnosis based on history and physical examination and includes symptoms of airway obstruction, generalized skin reactions, particularly flushing, itching, urticaria, angioedema cardiovascular symptoms including hypotension and gastrointestinal symptoms. These symptoms result from the action of mast cell mediators, especially histamine and lipid mediators such as leukotrienes and platelet activating factor on shock tissue. The shock tissue includes blood vessels, mucous glands, smooth muscle, and nerve endings. Anaphylaxis follows the typical immediate hypersensitivity time course, with a reaction beginning within minutes of antigen exposure. A late-phase reaction hours after the initial reaction may occur. Mast cell mediator release can be triggered by both IgE and non--IgE-mediated factors. Therefore, anaphylaxis may be termed anaphylaxis (IgE mediated) or anaphylactoid (non--IgE mediated). The most common IgE-mediated triggers are drugs, typically penicillin or other beta-lactam antibiotics, foods, most commonly nuts, peanuts, fish and shellfish, or hymenoptera stings. Non-IgE-mediated causes include factors causing marked complement activation such as plasma proteins or compounds which act directly on the mast cell membrane, such as vancomycin, quinolone antibiotics, or radiographic contrast media. The pathophysiology of some trigger factors, such as aspirin, remains unclear. Therapy of anaphylaxis revolves around patient education, avoidance, desensitization or pharmacologic pretreatment when agents causing anaphylaxis need to be readministered, and early recognition and prompt therapy of reactions should they occur.
过敏反应是一种急性致命或潜在致命的超敏反应。过敏反应是基于病史和体格检查做出的临床诊断，包括气道阻塞症状、全身性皮肤反应，特别是潮红、瘙痒、荨麻疹、血管性水肿，心血管症状如低血压以及胃肠道症状。这些症状是肥大细胞介质，特别是组胺和脂质介质如白三烯和血小板活化因子作用于休克组织的结果。休克组织包括血管、黏液腺、平滑肌和神经末梢。过敏反应遵循典型的速发型超敏反应时间进程，在接触抗原后数分钟内开始出现反应。初始反应数小时后可能会发生迟发性反应。肥大细胞介质的释放可由IgE介导和非IgE介导的因素触发。因此，过敏反应可称为过敏性反应（IgE介导）或类过敏反应（非IgE介导）。最常见的IgE介导的触发因素是药物，通常是青霉素或其他β-内酰胺类抗生素、食物，最常见的是坚果、花生、鱼和贝类，或膜翅目昆虫叮咬。非IgE介导的原因包括导致显著补体激活的因素，如血浆蛋白或直接作用于肥大细胞膜的化合物，如万古霉素、喹诺酮类抗生素或放射造影剂。一些触发因素如阿司匹林的病理生理学仍不清楚。过敏反应的治疗围绕患者教育、避免接触、脱敏或在需要重新使用引起过敏反应的药物时进行药物预处理，以及在反应发生时尽早识别并迅速治疗。
