Golden David B K
Johns Hopkins University, 733 North Broadway, Baltimore, MD 21205, USA.
Immunol Allergy Clin North Am. 2007 May;27(2):261-72, vii. doi: 10.1016/j.iac.2007.03.008.
Anaphylaxis to insect stings has occurred in 3% of adults and can be fatal even on the first reaction. Large local reactions are more frequent but rarely dangerous. The chance of a systemic reaction to a sting is low (5% to 10%) in large local reactors and in children with mild (cutaneous) systemic reactions, and varies between 25% and 70% in adults depending on the severity of previous sting reactions. Venom skin tests are most accurate for diagnosis, but the radioallergosorbent test (RAST) is an important complementary test. The degree of sensitivity on skin test or RAST does not predict the severity of a sting reaction reliably. Venom sensitization can be detected in 25% of adults, so the history is most important. Venom immunotherapy is 75% to 98% effective in preventing sting anaphylaxis. Most patients can discontinue treatment after 5 years, with very low residual risk of a severe sting reaction.
3%的成年人会发生昆虫叮咬过敏反应，甚至首次反应就可能致命。大的局部反应更为常见，但很少有危险。在出现大的局部反应的患者以及有轻度（皮肤）全身反应的儿童中，叮咬引发全身反应的几率较低（5%至10%），而在成年人中，根据既往叮咬反应的严重程度，这一几率在25%至70%之间变化。毒液皮肤试验对诊断最为准确，但放射变应原吸附试验（RAST）是一项重要的补充试验。皮肤试验或RAST的敏感程度并不能可靠地预测叮咬反应的严重程度。25%的成年人可检测到毒液致敏，因此病史最为重要。毒液免疫疗法预防叮咬过敏反应的有效率为75%至98%。大多数患者在5年后可以停止治疗，严重叮咬反应的残留风险非常低。
