Golden David B K
Johns Hopkins University School of Medicine, Asthma and Allergy Center, Baltimore, Maryland 21224, USA.
Am Fam Physician. 2003 Jun 15;67(12):2541-6.
Systemic allergic reactions to insect stings are estimated to occur in about 1 percent of children and 3 percent of adults. In children, these reactions usually are limited to cutaneous signs, with urticaria and angioedema; adults more commonly have airway obstruction or hypotension. Epinephrine is the treatment of choice for acute anaphylaxis, and self-injection devices should be prescribed to patients at risk for this allergic reaction. Stinging insect allergy can be confirmed by measurement of venom-specific IgE antibodies using venom skin tests or a radioallergosorbent test. Patients with previous large local reactions have a 5 to 10 percent risk of experiencing systemic reactions to future stings. Patients with previous systemic reactions have a variable risk of future reactions: the risk is as low as 10 to 15 percent in those with the mildest reactions and in some children, but as high as 70 percent in adults with the most severe recent reactions. Because of demonstrated efficacy (98 percent), venom immunotherapy is recommended for use in patients who are at risk for severe systemic reactions to future insect stings. Venom immunotherapy is administered every four to eight weeks for at least five years. Immunotherapy may be needed indefinitely in patients at higher risk for recurrence of anaphylaxis after treatment is stopped.
据估计，约1%的儿童和3%的成人会发生对昆虫叮咬的全身性过敏反应。在儿童中，这些反应通常局限于皮肤症状，如荨麻疹和血管性水肿；成人更常见的是气道阻塞或低血压。肾上腺素是急性过敏反应的首选治疗药物，对于有这种过敏反应风险的患者应开具自动注射装置。通过使用毒液皮肤试验或放射变应原吸附试验检测毒液特异性IgE抗体，可以确诊昆虫叮咬过敏。既往有严重局部反应的患者，未来再次被叮咬时发生全身性反应的风险为5%至10%。既往有全身性反应的患者，未来发生反应的风险各不相同：反应最轻的患者和一些儿童的风险低至10%至15%，但近期反应最严重的成人风险高达70%。由于已证实有效（98%），毒液免疫疗法推荐用于有未来昆虫叮咬发生严重全身性反应风险的患者。毒液免疫疗法每四至八周进行一次，至少持续五年。对于治疗停止后过敏反应复发风险较高的患者，可能需要无限期进行免疫治疗。
