特发性过敏反应的预防性治疗结果。

Wong S, Yarnold P R, Yango C, Patterson R, Harris K E

Northwestern University Medical School, Chicago, Illinois.

Ann Intern Med. 1991 Jan 15;114(2):133-6. doi: 10.7326/0003-4819-114-2-133.

OBJECTIVE

To determine the efficacy of a prophylactic regimen (prednisone, H1 blockade, and sympathomimetic amine therapy) in patients with idiopathic anaphylaxis.

DESIGN

Clinical trial before and after treatment.

SETTING

Referral-based allergy clinic at a major medical center.

PATIENTS

Fifty-three patients with a history compatible with idiopathic anaphylaxis for at least 6 months before presentation to the allergy service and with subsequent management by the service for at least 6 months.

INTERVENTIONS

Patients with frequent life-threatening symptoms were treated with a prophylactic regimen. Patients with infrequent episodes of idiopathic anaphylaxis were only treated acutely for each episode of anaphylaxis.

MEASUREMENTS AND MAIN RESULTS

The results favored prophylactic treatment with prednisone for patients who were classified as generalized-frequent in the clinical outcome measures of frequency (per patient per year) of episodes (mean before treatment, 7.31 +/- 6.46; after treatment, 3.61 +/- 4.73; P less than 0.02) and emergency room visits (mean before treatment, 1.94 +/- 3.42; after treatment, 0.21 +/- 0.44; P less than 0.005) and for patients classified as angioedema-frequent in the frequency of episodes (mean before treatment, 14.93 +/- 15.89; after treatment, 2.58 +/- 2.18; P less than 0.003) and emergency room visits (mean before treatment, 0.76 +/- 1.01; after treatment, 0.07 +/- 0.11; P less than 0.025). No statistically significant difference was found for patients classified as generalized-infrequent in the frequency of episodes (mean before treatment, 2.01 +/- 1.30; after treatment, 1.36 +/- 1.79) or of the emergency room visits (mean before treatment, 0.56 +/- 0.71; after treatment, 0.32 +/- 0.75) or for patients classified as angioedema-infrequent in the frequency of episodes (mean before treatment, 1.94 +/- 1.55; after treatment, 2.03 +/- 2.16) or of emergency room visits (mean before treatment, 0.27 +/- 0.44; after treatment, 0.37 +/- 0.59).

CONCLUSIONS

Prophylactic treatment with prednisone and H1 antihistamines with or without sympathomimetic amines improves clinical outcome in patients who are classified as idiopathic anaphylaxis-angioedema frequent and idiopathic anaphylaxis-generalized frequent.

目的

确定预防性治疗方案（泼尼松、H1 受体阻断剂和拟交感神经胺疗法）对特发性过敏反应患者的疗效。

设计

治疗前后的临床试验。

地点

一家大型医疗中心基于转诊的过敏诊所。

患者

53 例患者，其病史与特发性过敏反应相符，在就诊于过敏科之前至少有 6 个月，且随后由该科室管理至少 6 个月。

干预措施

有频繁危及生命症状的患者接受预防性治疗方案。特发性过敏反应发作不频繁的患者仅在每次过敏反应发作时进行急性治疗。

测量指标及主要结果

在发作频率（每年每位患者）的临床结局测量中，对于分类为全身性发作频繁的患者（治疗前均值，7.31±6.46；治疗后，3.61±4.73；P＜0.02）和急诊就诊次数（治疗前均值，1.94±3.42；治疗后，0.21±0.44；P＜0.005），以及分类为血管性水肿发作频繁的患者（发作频率治疗前均值，14.93±15.89；治疗后，2.58±2.18；P＜0.003）和急诊就诊次数（治疗前均值，0.76±1.01；治疗后，0.07±0.11；P＜0.025），结果显示泼尼松预防性治疗有效。对于分类为全身性发作不频繁的患者（发作频率治疗前均值，2.01±1.30；治疗后，1.36±1.79）或急诊就诊次数（治疗前均值，0.56±0.71；治疗后，0.32±0.75），以及分类为血管性水肿发作不频繁的患者（发作频率治疗前均值，1.94±1.55；治疗后，2.03±2.16）或急诊就诊次数（治疗前均值，0.27±0.44；治疗后，0.37±0.59），未发现统计学上的显著差异。