Moneret-Vautrin D A, Morisset M, Flabbee J, Beaudouin E, Kanny G
Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, Nancy Cedex, France.
Allergy. 2005 Apr;60(4):443-51. doi: 10.1111/j.1398-9995.2005.00785.x.
Severe anaphylaxis is a systemic reaction affecting two or more organs or systems and is due to the release of active mediators from mast cells and basophils. A four-grade classification routinely places 'severe' anaphylaxis in grades 3 and 4 (death could be graded as grade 5). Studies are underway to determine the prevalence of severe and lethal anaphylaxis in different populations and the relative frequencies of food, drug, latex and Hymenoptera anaphylaxis. These studies will also analyse the risk arising from the lack of preventive measures applied in schools (personalized management protocols) and from the insufficient use of self-injected adrenalin. Allergy-related conditions may account for 0.2-1% of emergency consultations. Severe anaphylaxis affects 1-3 per 10 000 people, but for the United States and Australia figures are even higher. It is estimated to cause death in 0.65-2% of patients, i.e. 1-3 per million people. An increased prevalence has been revealed by monitoring hospitalized populations by reference to the international classification of disease (ICD) codes. The relative frequency of aetiological factors of allergy (food, drugs, insects and latex) varies in different studies. Food, drug and Hymenoptera allergies are potentially lethal. The risk of food-mediated anaphylaxis can be assessed from the number of personalized management protocols in French schools: 0.065%. Another means of assessment may be the rate of adrenalin prescriptions. However, an overestimation of the anaphylaxis risk may result from this method (0.95% of Canadian children). Data from the literature leads to several possibilities. First, a definition of severe anaphylaxis should be agreed. Secondly, prospective, multicentre enquiries, using ICD codes, should be implemented. Moreover, the high number of anaphylaxis cases for which the aetiology is not identified, and the variation in aetiology in the published series, indicate that a closer cooperation between emergency specialists and allergists is essential.
严重过敏反应是一种影响两个或更多器官或系统的全身性反应，由肥大细胞和嗜碱性粒细胞释放活性介质所致。四级分类法通常将“严重”过敏反应归为3级和4级（死亡可归为5级）。目前正在进行研究，以确定不同人群中严重和致死性过敏反应的患病率，以及食物、药物、乳胶和膜翅目昆虫过敏反应的相对频率。这些研究还将分析因学校缺乏预防措施（个性化管理方案）以及自行注射肾上腺素使用不足而产生的风险。与过敏相关的病症可能占急诊会诊病例的0.2 - 1%。严重过敏反应影响着万分之一至万分之三的人群，但在美国和澳大利亚，这一数字甚至更高。据估计，严重过敏反应导致0.65 - 2%的患者死亡，即每百万人中有1 - 3人死亡。通过参照国际疾病分类（ICD）编码对住院人群进行监测，发现患病率有所上升。不同研究中过敏病因（食物、药物、昆虫和乳胶）的相对频率各不相同。食物、药物和膜翅目昆虫过敏有潜在致死性。食物介导的过敏反应风险可根据法国学校个性化管理方案的数量来评估：0.065%。另一种评估方法可能是肾上腺素处方率。然而，这种方法可能会高估过敏反应风险（加拿大儿童中有0.95%）。文献数据带来了几种可能性。首先，应就严重过敏反应的定义达成共识。其次，则应采用ICD编码开展前瞻性多中心调查。此外，大量病因不明的过敏反应病例以及已发表系列研究中病因的差异表明，急诊专家和过敏症专科医生之间的密切合作至关重要。
