Lieberman Phil L
Divisions of Allergy and Immunology, Departments of Medicine and Pediatrics, University of Tennessee, College of Medicine Memphis, Tennessee, USA.
Allergy Asthma Proc. 2014 Jan-Feb;35(1):17-23. doi: 10.2500/aap.2014.35.3717.
Idiopathic anaphylaxis is not uncommon and can be found in as many as 60% of patients referred to an allergist for anaphylactic events. It is an extremely frustrating condition for patients because they have no means of avoiding a known allergen and events occur spontaneously and unprovoked. The objective of this study was to synthesize and review the medical literature on idiopathic anaphylaxis and present a strategy for diagnosis, prevention, and treatment of episodes. A literature review was performed after a search of PubMed using the key words of idiopathic anaphylaxis. Idiopathic anaphylaxis is more common in adults than in children and in women than in men. The symptoms and signs are identical to those found in other causes of anaphylaxis. Perhaps the most common entities to be considered in the differential diagnosis are somatoform reactions. The two most recent advances in our ability to detect the cause are the discovery that episodes can be caused by mast cell-activating syndromes, systemic mastocytosis, and IgE to galactose-alpha-1,3-galactose. Patients experiencing idiopathic anaphylactic episodes should, if possible, avoid taking drugs that may complicate therapy or worsen a reaction. Fortunately, the vast majority of cases follow a benign course. Although many recurrent episodes of anaphylaxis remain idiopathic, recent advances in our knowledge, especially the description of mast cell-activating disorders and the discovery of anaphylactic reactions to galactose-α-1,3-galactose have allowed us to find causes in events that previously would have been classified as idiopathic. In addition, the majority of such patients exhibit a diminishing frequency of reactions over time and can be managed in a way that prevents mortality and a severe effect on their quality of life.
特发性过敏反应并不罕见，在因过敏反应而转诊至过敏症专科医生处的患者中，多达60%的人患有此病。对患者来说，这是一种极其令人沮丧的病症，因为他们无法避免已知的过敏原，而且过敏反应会自发且毫无缘由地发生。本研究的目的是综合并综述关于特发性过敏反应的医学文献，并提出针对发作的诊断、预防和治疗策略。在使用关键词“特发性过敏反应”搜索PubMed后进行了文献综述。特发性过敏反应在成年人中比在儿童中更常见，在女性中比在男性中更常见。其症状和体征与其他过敏反应原因所导致的症状和体征相同。在鉴别诊断中可能最需要考虑的常见情况是躯体形式反应。在病因检测方面，我们最近取得的两项进展是发现发作可能由肥大细胞活化综合征、系统性肥大细胞增多症以及对半乳糖-α-1,3-半乳糖的IgE引起。经历特发性过敏反应发作的患者，如果可能的话，应避免服用可能使治疗复杂化或使反应恶化的药物。幸运的是，绝大多数病例呈良性病程。尽管许多过敏反应的反复发作仍为特发性，但我们在知识方面的最新进展，尤其是对肥大细胞活化障碍的描述以及对半乳糖-α-1,3-半乳糖过敏反应的发现，使我们能够在以前会被归类为特发性的事件中找到病因。此外，大多数此类患者随着时间推移反应频率会降低，并且可以通过预防死亡和严重影响其生活质量的方式进行管理。
