Kemp Ann M, Kemp Stephen F
aDepartment of Family Medicine bDivision of Clinical Immunology and Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Curr Opin Allergy Clin Immunol. 2014 Aug;14(4):371-8. doi: 10.1097/ACI.0000000000000080.
This review aims to provide an evidence-based overview of several pharmacotherapeutic options available for refractory anaphylaxis when intramuscular epinephrine, the drug of choice, fails to provide resolution of signs and symptoms.
The evidence base for the therapy of anaphylaxis is comparatively weak and is largely based on consensus expert recommendations and case reports. There is an increasing recognition that this is problematic. The level of evidence for epinephrine use in anaphylaxis is higher than for other agents. Recent systematic reviews have confirmed the lack of high-grade evidence to support use of antihistamines and corticosteroids in anaphylaxis, both of which statistically continue to be used more frequently than epinephrine. Newer pharmacotherapeutic agents have been proffered, but none has been evaluated with scientific rigor.
Some anaphylactic reactions are so severe that treatment is unsuccessful despite rapid recognition and treatment. Improving the evidence base for the various treatment modalities may further help minimize fatalities once anaphylaxis is recognized. Consensus expert recommendations and case reports suggest a number of pharmacotherapeutic agents that are worthy of high-quality scrutiny through randomized controlled studies in which both treatment and placebo arms receive intramuscular epinephrine injections.
本综述旨在对难治性过敏反应的几种药物治疗选择进行循证概述，当首选药物肌肉注射肾上腺素无法缓解体征和症状时。
过敏反应治疗的证据基础相对薄弱，主要基于专家共识推荐和病例报告。人们越来越认识到这存在问题。肾上腺素用于过敏反应的证据水平高于其他药物。最近的系统评价证实，缺乏支持在过敏反应中使用抗组胺药和皮质类固醇的高级别证据，而这两种药物在统计学上的使用频率仍高于肾上腺素。已提出了更新的药物治疗药物，但均未经过科学严格评估。
一些过敏反应非常严重，尽管能迅速识别并进行治疗，但治疗仍不成功。改善各种治疗方式的证据基础可能进一步有助于在识别过敏反应后将死亡人数降至最低。专家共识推荐和病例报告表明，一些药物治疗药物值得通过随机对照研究进行高质量审查，其中治疗组和安慰剂组均接受肌肉注射肾上腺素。
