Brown Simon G A
Department of Emergency Medicine, Royal Hobart Hospital Australia.
J Allergy Clin Immunol. 2004 Aug;114(2):371-6. doi: 10.1016/j.jaci.2004.04.029.
Existing grading systems for acute systemic hypersensitivity reactions vary considerably, have a number of deficiencies, and lack a consistent definition of anaphylaxis.
The aims of this study were to develop a simple grading system and definition of anaphylaxis and to identify predictors of reaction severity.
Case records from 1149 systemic hypersensitivity reactions presenting to an emergency department were analyzed retrospectively. Logistic regression analyses of the associations between individual reaction features and hypotension and hypoxia were used to construct a grading system. Epinephrine use, etiology, age, sex, comorbidities, and concurrent medications were then assessed for their association with reaction grade.
Confusion, collapse, unconsciousness, and incontinence were strongly associated with hypotension and hypoxia and were used to define severe reactions. Diaphoresis, vomiting, presyncope, dyspnea, stridor, wheeze, chest/throat tightness, nausea, vomiting, and abdominal pain had weaker, albeit significant, associations and were used to define moderate reactions. Reactions limited to the skin (urticaria, erythema, and angioedema) were defined as mild. These grades correlated well with epinephrine usage. Older age, insect venom, and iatrogenic causes were independent predictors of severity. Preexisting lung disease was associated with an increased risk of hypoxia.
This simple grading system has potential value for defining reaction severity in clinical practice and research settings. The moderate and severe grades provide a workable definition of anaphylaxis. Age, reaction precipitant, and preexisting lung disease appear to be the major determinants of reaction severity.
现有的急性全身性过敏反应分级系统差异很大，存在诸多缺陷，且缺乏对过敏反应的一致定义。
本研究旨在开发一种简单的分级系统和过敏反应定义，并确定反应严重程度的预测因素。
回顾性分析了1149例到急诊科就诊的全身性过敏反应的病例记录。通过对个体反应特征与低血压和低氧血症之间关联的逻辑回归分析来构建分级系统。然后评估肾上腺素的使用、病因、年龄、性别、合并症和同时使用的药物与反应分级的关联。
意识模糊、虚脱、昏迷和大小便失禁与低血压和低氧血症密切相关，用于定义严重反应。出汗、呕吐、晕厥前状态、呼吸困难、喘鸣、喘息、胸部/喉咙发紧、恶心、呕吐和腹痛的关联性较弱，尽管有统计学意义，用于定义中度反应。仅限于皮肤的反应（荨麻疹、红斑和血管性水肿）定义为轻度。这些分级与肾上腺素的使用情况相关性良好。年龄较大、昆虫毒液和医源性原因是严重程度的独立预测因素。既往肺部疾病与低氧血症风险增加有关。
这种简单的分级系统在临床实践和研究环境中对于定义反应严重程度具有潜在价值。中度和重度分级为过敏反应提供了可行的定义。年龄、反应诱发因素和既往肺部疾病似乎是反应严重程度的主要决定因素。
