Oude Elberink Joanne N G, Dubois Anthony E J
Department of Allergology, University HospitalGroningen, Groningen, The Netherlands.
Curr Opin Allergy Clin Immunol. 2003 Aug;3(4):287-93. doi: 10.1097/00130832-200308000-00009.
As re-sting rates and mortality in Hymenoptera allergy are generally low, health related quality of life is an important therapeutic target in the treatment of allergic patients. This review focuses on the impact of anaphylactic reactions and the effect of interventions in health related quality of life for Hymenoptera allergic patients.
Anaphylactic reactions following insect stings can have a great impact on the quality of life of insect sting allergic patients. Venom immunotherapy, with information about the risks and benefits of the treatment, was shown to improve health related quality of life. There were no patients whose health related quality of life was so severely impaired that they did not improve with venom immunotherapy. Treatment with an Epipen (ALK-Abello, Nieuwegein, The Netherlands) resulted in a deterioration in health related quality of life.
These findings suggest that patient education of these risks and benefits is as important as the treatment itself in order to achieve all the important therapeutic goals of venom immunotherapy. For most patients the Epipen is insufficient as definitive treatment from a quality of life point of view. Although the low mortality, morbidity and re-sting frequency in Hymenoptera allergic patients has led some authorities to conclude that many patients are treated unnecessarily, this conclusion is refuted by the fact that venom immunotherapy improves health related quality of life in the vast majority of patients receiving this treatment, even if they are not re-stung.
由于膜翅目过敏的再叮咬率和死亡率普遍较低，与健康相关的生活质量是过敏患者治疗中的一个重要治疗目标。本综述重点关注过敏反应的影响以及针对膜翅目过敏患者的干预措施对与健康相关生活质量的作用。
昆虫叮咬后的过敏反应会对昆虫叮咬过敏患者的生活质量产生重大影响。毒液免疫疗法，并告知患者治疗的风险和益处，已显示可改善与健康相关的生活质量。没有患者的与健康相关的生活质量严重受损到接受毒液免疫疗法后仍无改善。使用肾上腺素笔（ALK - Abello，荷兰尼乌韦根）进行治疗会导致与健康相关的生活质量恶化。
这些发现表明，为了实现毒液免疫疗法的所有重要治疗目标，对这些风险和益处进行患者教育与治疗本身同样重要。从生活质量的角度来看，对于大多数患者而言，肾上腺素笔作为确定性治疗是不够的。尽管膜翅目过敏患者的死亡率、发病率和再叮咬频率较低，一些权威机构据此得出许多患者接受了不必要治疗的结论，但事实上毒液免疫疗法能改善绝大多数接受该治疗患者的与健康相关的生活质量，即便他们没有再次被叮咬，这一结论遭到了反驳。
