Webb Luke M, Lieberman Phil
Department of Internal Medicine, University of Tennessee, Germantown, Tennessee, USA.
Ann Allergy Asthma Immunol. 2006 Jul;97(1):39-43. doi: 10.1016/S1081-1206(10)61367-1.
The allergist usually sees patients with anaphylaxis after the event for the purposes of identifying the cause, establishing a prognosis, and preventing further episodes. Knowledge of the characteristics of such patients is essential to achieve these goals.
To examine the natural history, clinical manifestations, and factors that affect the patients' adherence to suggested treatment and preventive strategies of anaphylaxis.
A retrospective medical record review spanning 25 years (1978-2003) and follow-up questionnaires were used to obtain data on 601 patients who presented with anaphylaxis of unknown origin to a private university-affiliated allergy-immunology practice.
Patients ranged in age from 1 to 79 years, with a mean age of 37 years. Females comprised 62% of cases. Causes of anaphylaxis were elucidated in 41% of cases. Known causes included foods in 131 patients (22%), medications in 69 cases (11%), and exercise in 31 cases (5%). Two hundred twenty-three patients (37%) were found to be atopic by history confirmed with skin prick testing. The most common manifestation was urticaria and/or angioedema, reported in 87% of patients. Systemic mastocytosis was found in 3 patients. Episodes tended to decline in frequency with time. Adherence to instructions to carry epinephrine can be improved with more effective teaching.
In most cases, the cause of anaphylaxis is undetermined. Women are affected more commonly than men. Systemic mastocytosis should be considered in cases of idiopathic anaphylaxis, and patients with a history of atopy are at an increased risk of developing anaphylaxis. Patients are more reliably carrying epinephrine as a result of changes in physician instructions. Finally, anaphylactic episodes tend to decrease in frequency and severity with time.
过敏症专科医生通常在过敏反应发生后诊治患者，目的是确定病因、判断预后并预防再次发作。了解此类患者的特征对于实现这些目标至关重要。
研究过敏反应患者的自然病史、临床表现以及影响患者遵循建议的治疗和预防策略的因素。
通过回顾25年（1978 - 2003年）的病历记录，并使用随访问卷，获取了601例病因不明的过敏反应患者的数据，这些患者均在一所私立大学附属的过敏 - 免疫学诊所就诊。
患者年龄从1岁至79岁不等，平均年龄为37岁。女性占病例的62%。41%的病例明确了过敏反应的病因。已知病因包括食物过敏131例（22%）、药物过敏69例（11%）、运动诱发过敏31例（5%）。经皮肤点刺试验证实，223例（37%）患者有特应性病史。最常见的表现是荨麻疹和/或血管性水肿，87%的患者有此症状。发现3例系统性肥大细胞增多症患者。发作频率往往随时间下降。通过更有效的宣教可提高患者携带肾上腺素的依从性。
在大多数情况下，过敏反应的病因尚不确定。女性比男性更易受影响。特发性过敏反应病例应考虑系统性肥大细胞增多症，有特应性病史的患者发生过敏反应的风险增加。由于医生指导的改变，患者携带肾上腺素的情况更可靠。最后，过敏反应发作的频率和严重程度往往随时间降低。
