Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
Allergy. 2010 Jul;65(7):919-23. doi: 10.1111/j.1398-9995.2009.02302.x. Epub 2010 Feb 1.
Epidemiologic studies suggest that elderly people are more prone to develop severe anaphylactic reactions. However, the exact cause for this phenomenon remains unclear.
To study the role of the serum tryptase as a diagnostic parameter for individual risk evaluation and its impact on the severity of allergic reactions in elderly people.
Two hundred and seventy-four consecutive patients visiting the Department of Dermatology, Tübingen, Germany, who were diagnosed with honeybee or wasp venom allergy, were included in the study.
Sting reaction severity increased with increased age and tryptase levels (P = 0.001 and P = 0.0003, respectively). Furthermore, we find not only a general increment in tryptase levels in elderly people (P = 0.0001) but also a continuous increase in tryptase concentrations even below the cut-off (11.4 microg/l) with increasing age (P = 0.0026).
Our data confirm serum tryptase as a risk factor for severe anaphylactic reaction to hymenoptera stings. Furthermore, we give first evidence that basal serum tryptase levels increase continuously with age and being an indicator for either increased mast cell load or reactivity this can at least partly be responsible for the observed aggravated allergic reactions in elderly people. As those patients are at increased risk for life-threatening anaphylactic reactions, it should be considered to adjust VIT especially in elderly patients with elevated tryptase levels as recommended for patients with mastocytosis by increasing venom doses during VIT and by considering its life-long continuation.
流行病学研究表明，老年人更容易发生严重的过敏反应。然而，这种现象的确切原因尚不清楚。
研究血清类胰蛋白酶作为个体风险评估的诊断参数的作用及其对老年人过敏反应严重程度的影响。
本研究纳入了 274 名连续就诊于德国图宾根皮肤科的被诊断为蜜蜂或黄蜂毒液过敏的患者。
蜇伤反应的严重程度随年龄和类胰蛋白酶水平的增加而增加（P = 0.001 和 P = 0.0003）。此外，我们不仅发现老年人的类胰蛋白酶水平普遍升高（P = 0.0001），而且即使在低于临界值（11.4μg/l）的情况下，类胰蛋白酶浓度也随着年龄的增加而持续升高（P = 0.0026）。
我们的数据证实血清类胰蛋白酶是蜂蜇后严重过敏反应的危险因素。此外，我们首次提供证据表明，基础血清类胰蛋白酶水平随年龄持续增加，并且是肥大细胞负荷或反应性增加的指标，这至少可以部分解释观察到的老年人过敏反应加重的原因。由于这些患者发生危及生命的过敏反应的风险增加，因此应考虑调整 VIT，特别是对于类胰蛋白酶水平升高的老年患者，建议增加 VIT 期间的毒液剂量，并考虑其终身延续。
