Reisman R E, Livingston A
Buffalo General Hospital, Department of Medicine, State University of New York 14203.
J Allergy Clin Immunol. 1989 Sep;84(3):331-7. doi: 10.1016/0091-6749(89)90417-x.
Allergic reactions after insect stings may have a delayed onset, differing from the usual immediate anaphylactic pattern. Ten patients, aged 6 to 78 years, had allergic reactions 1 to 2 weeks after an insect sting. Six patients had had multiple stings preceding the reaction. In two instances, immediate anaphylaxis also occurred. Four of the 10 patients had serum sickness-type reactions; two other patients had more severe anaphylactic symptoms, including throat edema. All patients in this group had venom-specific IgE; four of the 10 patients had serum venom-specific IgG. Eight patients subsequently received venom immunotherapy (VIT). There have been no reactions from seven re-stings. Five patients had generalized hives starting 6 to 24 hours after an insect sting. All patients in this group had venom-specific IgE; three patients have received VIT. Two other patients developed hives, one with throat edema 3 days after an insect sting. Both patients had high titers of serum venom-specific IgE; neither patient has received VIT, one patient because of extreme sensitivity. These observations suggest that after an insect sting, patients may develop delayed-onset allergic symptoms that range from typical anaphylaxis to serum sickness and are mediated by venom-specific IgE. VIT is recommended for patients with these reactions.
昆虫叮咬后的过敏反应可能会延迟发作，这与通常的速发型过敏模式不同。10名年龄在6至78岁的患者在昆虫叮咬后1至2周出现了过敏反应。6名患者在反应发生前曾多次被叮咬。有两例还出现了速发型过敏反应。10名患者中有4名出现血清病样反应；另外两名患者出现了更严重的过敏症状，包括喉部水肿。该组所有患者均有针对毒液的IgE；10名患者中有4名有血清毒液特异性IgG。8名患者随后接受了毒液免疫疗法（VIT）。再次被叮咬7次均未出现反应。5名患者在昆虫叮咬后6至24小时出现全身性荨麻疹。该组所有患者均有针对毒液的IgE；3名患者接受了VIT。另外两名患者出现荨麻疹，其中一名在昆虫叮咬后3天出现喉部水肿。两名患者血清毒液特异性IgE滴度均很高；两名患者均未接受VIT，其中一名患者是因为极度敏感。这些观察结果表明，昆虫叮咬后，患者可能会出现延迟发作的过敏症状，范围从典型的过敏反应到血清病，且由毒液特异性IgE介导。建议对有这些反应的患者进行VIT。
