Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland.
J Investig Allergol Clin Immunol. 2011;21(4):260-9.
We performed a prospective study to analyze mast cell mediators as predictors of systemic adverse reactions during rush venom-specific immunotherapy (VIT) in children.
Nineteen children aged 5-17 years received VIT with Venomenhal (HALAllergy). We analyzed serum tryptase (CAP, Phadia), plasma prostaglandin (PG) D2 metabolites (9alpha, 11beta-PGF2), and urine PGD2 metabolites (9alpha, 11beta-PGF2, tetranor-PGD-M) using gas chromatography mass spectrometry before and after the rush protocol.
Three boys with high baseline serum tryptase values (>7.76 g/L) (P < .001) and low 9alpha, 11beta-PGF2 concentrations developed grade III systemic adverse reactions during VIT. Baseline serum tryptase was lowest in children who had a Mueller grade II reaction (1.93 [0.36]) before VIT and highest in children with a Mueller grade III reaction (6.31 [4.80]) (P = .029). Repeated measures analysis of variance confirmed that, in children who developed systemic adverse reactions during VIT, serum tryptase was higher both before and after desensitization and increased significantly following the procedure. Analysis of PGD2 metabolites in the prediction of systemic adverse reactions during VIT was inadequate (sensitivity 67% and specificity 0.53%), whilst prediction based on serum tryptase was accurate.
In children with severe systemic adverse reactions to Hymenoptera sting, the evaluation of baseline tryptase levels should be a standard procedure. Children with Apis mellifera venom allergy and baseline tryptase levels higher than 7.75 g/L are at risk of anaphylaxis during buildup. Lower baseline values of plasma and urinary PGD2 metabolite concentration in patients with systemic adverse reaction during VIT suggest that prostaglandin catabolism is altered.
我们进行了一项前瞻性研究，以分析肥大细胞介质作为儿童速发型过敏原特异性免疫治疗（VIT）期间全身不良反应的预测因子。
19 名 5-17 岁的儿童接受 Venomenhal（HALAllergy）进行 VIT。我们使用气相色谱-质谱法分析了 rush 方案前后的血清类胰蛋白酶（CAP，Phadia）、血浆前列腺素（PG）D2 代谢物（9alpha，11beta-PGF2）和尿 PGD2 代谢物（9alpha，11beta-PGF2，四氢-Nor-PGD-M）。
3 名基线血清类胰蛋白酶值较高（>7.76 g/L）（P <.001）且 9alpha，11beta-PGF2 浓度较低的男孩在 VIT 期间发生了 III 级全身不良反应。VIT 前 Mueller 反应 II 级的儿童血清类胰蛋白酶最低（1.93 [0.36]），而 Mueller 反应 III 级的儿童血清类胰蛋白酶最高（6.31 [4.80]）（P =.029）。重复测量方差分析证实，在 VIT 期间发生全身不良反应的儿童中，脱敏前后的血清类胰蛋白酶均较高，且在治疗后显著升高。PGD2 代谢物分析用于预测 VIT 期间的全身不良反应效果不佳（灵敏度 67%，特异性 0.53%），而基于血清类胰蛋白酶的预测则较为准确。
在对蜂蜇有严重全身不良反应的儿童中，应将基线类胰蛋白酶水平的评估作为标准程序。阿比蜜蜂毒液过敏且基线类胰蛋白酶水平高于 7.75 g/L 的儿童在进行递增期时存在发生过敏反应的风险。VIT 期间发生全身不良反应的患者血浆和尿 PGD2 代谢物浓度的基线值较低表明前列腺素代谢发生改变。
