Mueller Ulrich R
Department of Medicine, Zieglerspital, Bern, Switzerland.
Curr Opin Allergy Clin Immunol. 2007 Aug;7(4):337-41. doi: 10.1097/ACI.0b013e328259c328.
In severe anaphylaxis, the cardiovascular system is often heavily involved. Preexisting cardiovascular disease may therefore influence the course of anaphylaxis in a negative way.
Systemic mastocytosis and elevated baseline serum tryptase are associated with severe and fatal anaphylaxis to hymenoptera stings. This is due to an increased number of cardiac mast cells resulting in high concentrations of cardiotoxic mast cell mediators in cardiac tissue during anaphylaxis. Severe anaphylaxis in coronary heart disease, in particular, is explained by an increased load of cardiac mast cells together with coronary stenosis favouring myocardial hypoxia. Contraindications for the use of medications for cardiac disease in patients with anaphylaxis, especially beta-blockers, have been questioned by epidemiologic studies considering the positive effects of these drugs on much more prevalent cardiac diseases.
Preexisting cardiovascular disease, mastocytosis and elevated baseline serum tryptase are risk factors for fatal anaphylactic reactions or lasting morbidity due to myocardial or cerebrovascular infarction induced by anaphylaxis. Life-saving cardiac medications like beta-blockers may increase the severity of anaphylaxis. Since life-threatening cardiovascular diseases are much more frequent than anaphylaxis, the relative risk of either disease with and without these drugs must be analyzed carefully together with the cardiologist.
在严重过敏反应中，心血管系统常受到严重影响。因此，既往存在的心血管疾病可能会对过敏反应的进程产生负面影响。
系统性肥大细胞增多症和基线血清类胰蛋白酶升高与膜翅目昆虫叮咬所致的严重和致命过敏反应相关。这是由于心脏肥大细胞数量增加，导致过敏反应期间心脏组织中心脏毒性肥大细胞介质浓度升高。特别是冠心病患者发生的严重过敏反应，是由于心脏肥大细胞负荷增加以及冠状动脉狭窄导致心肌缺氧所致。考虑到这些药物对更为常见的心脏疾病具有积极作用，流行病学研究对过敏反应患者使用心脏病药物（尤其是β受体阻滞剂）的禁忌提出了质疑。
既往存在的心血管疾病、肥大细胞增多症和基线血清类胰蛋白酶升高是因过敏反应诱发心肌梗死或脑血管梗死导致致命过敏反应或长期发病的危险因素。像β受体阻滞剂这样的救命心脏药物可能会增加过敏反应的严重程度。由于危及生命的心血管疾病比过敏反应更为常见，必须与心脏病专家一起仔细分析使用这些药物和不使用这些药物时两种疾病的相对风险。
