Fisher Malcolm
Intensive Therapy Unit, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
Novartis Found Symp. 2004;257:193-202; discussion 202-10, 276-85.
Severe anaphylactic reactions during anaesthesia increased dramatically in incidence in the mid 1970s. Studies performed in our unit over the subsequent 25 years demonstrated the involvement of IgE in these reactions and the value and safety of intradermal and prick testing in the diagnosis and determination of the drug responsible. Radioimmunoassay studies demonstrated that neuromuscular blocking drugs produce anaphylaxis by cross-linking IgE molecules via their substituted ammonium groups. The IgE binding of these drugs leads to a high incidence of cross sensitivity. Mast cell tryptase measurement is highly sensitive and specific for anaphylaxis although it can be elevated in reactions due to direct histamine release. The reactions are unpredictable from the history. The heart is rarely a target organ in human anaphylaxis although the diseased heart is more likely to fail or produce serious arrhythmias than the normal heart. Colloid solutions produce a better response than crystalloid solutions in the treatment of hypotension. Anaesthetic allergy persists up to 27 years. Subsequent anaesthesia based on the findings of skin testing is usually safe.
20世纪70年代中期，麻醉期间严重过敏反应的发生率急剧上升。在随后的25年里，我们单位进行的研究表明，IgE参与了这些反应，以及皮内试验和点刺试验在诊断和确定致病药物方面的价值和安全性。放射免疫分析研究表明，神经肌肉阻滞药物通过其取代铵基团交联IgE分子而引发过敏反应。这些药物与IgE的结合导致交叉敏感性的高发生率。肥大细胞类胰蛋白酶测量对过敏反应具有高度敏感性和特异性，尽管在直接组胺释放引起的反应中它可能会升高。这些反应从病史来看是不可预测的。在人类过敏反应中，心脏很少是靶器官，尽管患病心脏比正常心脏更有可能出现衰竭或产生严重心律失常。在治疗低血压方面，胶体溶液比晶体溶液产生更好的反应。麻醉过敏可持续长达27年。基于皮肤试验结果的后续麻醉通常是安全的。
