Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, VA.
West J Emerg Med. 2010 Dec;11(5):456-61.
The identification and appropriate management of those at highest risk for life-threatening anaphylaxis remains a clinical enigma. The most widely used criteria for such patients were developed in a symposium convened by National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network. In this paper we review the current literature on the diagnosis of acute allergic reactions as well as atypical presentations that clinicians should recognize. Review of case series reveals significant variability in definition and approach to this common and potentially life-threatening condition. Series on fatal cases of anaphylaxis indicate that mucocutaneous signs and symptoms occur less frequently than in milder cases. Of biomarkers studied to aid in the work-up of possible anaphylaxis, drawing blood during the initial six hours of an acute reaction for analysis of serum tryptase has been recommended in atypical cases. This can provide valuable information when a definitive diagnosis cannot be made by history and physical exam.
对于那些有生命威胁的严重过敏反应风险最高的患者的识别和适当管理仍然是一个临床难题。这些患者最广泛使用的标准是由过敏与传染病研究所/食物过敏与过敏反应网络组织的一次专题研讨会制定的。在本文中，我们回顾了关于急性过敏反应诊断的最新文献，以及临床医生应该识别的非典型表现。对病例系列的回顾显示，在这种常见且潜在危及生命的疾病的定义和处理方法上存在显著的差异。关于过敏反应致死病例的研究表明，粘膜皮肤症状比轻度病例发生得更少。在研究用于辅助可能的过敏反应检查的生物标志物时，建议在非典型病例中在急性反应的最初六小时内抽取血液进行血清类胰蛋白酶分析。当无法通过病史和体格检查做出明确诊断时，这可以提供有价值的信息。
