Department of Pediatrics & Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S161-81. doi: 10.1016/j.jaci.2009.12.981.
Anaphylaxis occurs commonly in community settings. The rate of occurrence is increasing, especially in young people. Understanding potential triggers, mechanisms, and patient-specific risk factors for severity and fatality is the key to performing appropriate risk assessment in those who have previously experienced an acute anaphylactic episode. The diagnosis of anaphylaxis is based primarily on clinical criteria and is valid even if the results of laboratory tests, such as serum total tryptase levels, are within normal limits. Positive skin test results or increased serum specific IgE levels to potential triggering allergens confirm sensitization but do not confirm the diagnosis of anaphylaxis because asymptomatic sensitization is common in the general population. Important patient-related risk factors for severity and fatality include age, concomitant diseases, and concurrent medications, as well as other less well-defined factors, such as defects in mediator degradation pathways, fever, acute infection, menses, emotional stress, and disruption of routine. Prevention of anaphylaxis depends primarily on optimal management of patient-related risk factors, strict avoidance of confirmed relevant allergen or other triggers, and, where indicated, immunomodulation (eg, subcutaneous venom immunotherapy to prevent Hymenoptera sting-triggered anaphylaxis, an underused, potentially curative treatment). The benefits and risks of immunomodulation to prevent food-triggered anaphylaxis are still being defined. Epinephrine (adrenaline) is the medication of first choice in the treatment of anaphylaxis. All patients at risk for recurrence in the community should be equipped with 1 or more epinephrine autoinjectors; a written, personalized anaphylaxis emergency action plan; and up-to-date medical identification. Improvements in the design of epinephrine autoinjectors will help to optimize ease of use and safety. Randomized controlled trials of pharmacologic agents, such as antihistamines and glucocorticoids, are needed to strengthen the evidence base for treatment of acute anaphylactic episodes.
过敏反应在社区环境中很常见。其发生率正在上升，尤其是在年轻人中。了解潜在的触发因素、机制以及患者严重程度和死亡率的特定风险因素是对曾经经历过急性过敏反应发作的人进行适当风险评估的关键。过敏反应的诊断主要基于临床标准，即使实验室检查结果（如血清总类胰蛋白酶水平）在正常范围内，该诊断也是有效的。阳性皮肤试验结果或潜在触发过敏原的血清特异性 IgE 水平升高可确认致敏，但不能确认过敏反应的诊断，因为无症状致敏在普通人群中很常见。严重程度和死亡率的重要患者相关风险因素包括年龄、合并症和同时使用的药物，以及其他不太明确的因素，如介质降解途径缺陷、发热、急性感染、月经、情绪压力和日常生活规律的打乱。过敏反应的预防主要取决于对患者相关风险因素的最佳管理、严格避免已确认的相关过敏原或其他触发因素，以及在有指征时进行免疫调节（例如，皮下毒液免疫疗法预防蜂蜇伤引发的过敏反应，这种治疗方法尚未得到充分应用，但有潜在疗效）。免疫调节预防食物引发过敏反应的益处和风险仍在确定中。肾上腺素（epinephrine）是治疗过敏反应的首选药物。所有有在社区中复发风险的患者都应配备 1 种或多种肾上腺素自动注射器；一份个性化的书面过敏反应紧急行动计划；以及最新的医疗身份证明。肾上腺素自动注射器设计的改进将有助于优化易用性和安全性。需要进行抗组胺药和糖皮质激素等药物的随机对照试验，以加强对急性过敏反应发作治疗的证据基础。
