Brown Simon G A, Mullins Raymond J, Gold Michael S
University of Western Australia, Fremantle Hospital, Fremantle, WA, Australia.
Med J Aust. 2006 Sep 4;185(5):283-9. doi: 10.5694/j.1326-5377.2006.tb00619.x.
Anaphylaxis is a serious, rapid-onset, allergic reaction that may cause death. Severe anaphylaxis is characterised by life-threatening upper airway obstruction, bronchospasm and/or hypotension. Anaphylaxis in children is most often caused by food. Bronchospasm is a common symptom, and there is usually a background of atopy and asthma. Venom- and drug-induced anaphylaxis are more common in adults, in whom hypotension is more likely to occur. Diagnosis can be difficult, with skin features being absent in up to 20% of people. Anaphylaxis must be considered as a differential diagnosis for any acute-onset respiratory distress, bronchospasm, hypotension or cardiac arrest. The cornerstones of initial management are putting the patient in the supine position, administering intramuscular adrenaline into the lateral thigh, resuscitation with intravenous fluid, support of the airway and ventilation, and giving supplementary oxygen. If the response to initial management is inadequate, intravenous infusion of adrenaline should be commenced. Use of vasopressors should be considered if hypotension persists. The patient should be observed for at least 4 hours after symptom resolution and referred to an allergist to assist with diagnosis, allergen avoidance measures, risk assessment, preparation of an action plan and education on the use of self-injectable adrenaline. Provision of a MedicAlert bracelet should also be arranged.
过敏反应是一种严重的、迅速发作的过敏反应，可能导致死亡。严重过敏反应的特征是危及生命的上呼吸道梗阻、支气管痉挛和/或低血压。儿童过敏反应最常见的原因是食物。支气管痉挛是常见症状，通常有特应性和哮喘病史。毒液和药物引起的过敏反应在成年人中更常见，成年人更易发生低血压。诊断可能困难，高达20%的人没有皮肤症状。对于任何急性发作的呼吸窘迫、支气管痉挛、低血压或心脏骤停，都必须考虑过敏反应作为鉴别诊断。初始治疗的基石是将患者置于仰卧位，在大腿外侧肌肉注射肾上腺素，静脉补液复苏，支持气道和通气，并给予补充氧气。如果对初始治疗的反应不足，应开始静脉输注肾上腺素。如果低血压持续存在，应考虑使用血管升压药。症状缓解后，患者应至少观察4小时，并转诊给过敏症专科医生，以协助诊断、避免接触过敏原措施、风险评估、制定行动计划以及进行自我注射肾上腺素使用的教育。还应安排佩戴医疗警示手环。
