Moneret-Vautrin Denise-Anne, Latarche Clothilde
Médecine interne, immunologie clinique et allergologie, Hôpital Central, Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy.
Bull Acad Natl Med. 2009 Feb;193(2):351-62; discussion 362-3.
Between 1995 and 2008, a case-control study was conducted to determine the role of drugs as risk factors for severe food anaphylaxis in adults. Data including exercise, alcohol intake, and use of aspirin, non steroidal anti-inflammatory drugs, beta-blockers, and angiotensin-converting-enzyme inhibitors (ACEI) were prospectively recorded. Multivariate analysis was used to compare 76 cases of severe anaphylaxis (SA) with 235 cases of mild to moderate food allergy (mmFA). The M/F sex ratio was 54.6% in SA and 36% in mmFA (p < .003). SA represented 17.3% of all food allergies below 45 years and 54.6% over this age. Drug intake did not differ between the two age categories. Drug use was noted in 40.8% of SA and 14.9% of mmFA (p < .0005). Aspirin, NSAIDs, betablockers and ACEI were associated with respectively 15.8%, 6.6%, 10.5% and 5.3% of SA, and with 1.7%, 0.9%, 1.7% and 0.4% of mmFA (p < .003). The respective odds ratios were 10.8, 8.2, 6.8 and 13.0. No other drugs were associated with FA. Exercise and alcohol intake were associated to drugs with respectively 10.5% and 27.6% of SA and 0.4% and 8.1% of mmFA (p < .0005). Exercise drastically increased the risk of drugs. We conclude that aspirin, NSAIDs, betablockers and ACEI are significant risk factors for severe IgE-dependent food allergy. The underlying mechanisms are discussed. Adults with food allergy or sensitization should avoid taking aspirin and NSAIDs before meals and should receive drug families other than ACEI and betablockers for hypertension. In case of pre-existing heart disease, the benefit-risk ratio of ACEI and beta-blockers has to be carefully considered.
1995年至2008年期间，开展了一项病例对照研究，以确定药物作为成人严重食物过敏反应风险因素的作用。前瞻性记录了包括运动、酒精摄入量以及阿司匹林、非甾体抗炎药、β受体阻滞剂和血管紧张素转换酶抑制剂（ACEI）使用情况等数据。采用多变量分析方法，对76例严重过敏反应（SA）病例与235例轻至中度食物过敏（mmFA）病例进行比较。SA组的男女比例为54.6%，mmFA组为36%（p < 0.003）。SA在45岁以下的所有食物过敏病例中占17.3%，在该年龄以上的病例中占54.6%。两个年龄组的药物摄入量无差异。SA组中有40.8%使用过药物，mmFA组为14.9%（p < 0.0005）。阿司匹林、非甾体抗炎药、β受体阻滞剂和ACEI在SA病例中分别占15.8%、6.6%、10.5%和5.3%，在mmFA病例中分别占1.7%、0.9%、1.7%和0.4%（p < 0.003）。各自的优势比分别为10.8、8.2、6.8和13.0。没有其他药物与食物过敏相关。运动和酒精摄入量与药物使用相关，在SA病例中分别占10.5%和27.6%，在mmFA病例中分别占0.4%和8.1%（p < 0.0005）。运动显著增加了药物导致过敏的风险。我们得出结论，阿司匹林、非甾体抗炎药、β受体阻滞剂和ACEI是严重IgE依赖型食物过敏的重要风险因素。对潜在机制进行了讨论。有食物过敏或致敏的成年人应避免在饭前服用阿司匹林和非甾体抗炎药，对于高血压患者，应使用除ACEI和β受体阻滞剂以外的其他药物类别。对于已有心脏病的患者，必须仔细考虑ACEI和β受体阻滞剂的效益风险比。
