Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol. 2017 Aug;140(2):321-333. doi: 10.1016/j.jaci.2017.06.012.
Anaphylaxis is the most severe and frightening of the allergic reactions, placing patients at high risk and demanding prompt recognition and immediate management by health care providers. Yet because its symptoms imitate those of other diseases, such as asthma and urticaria, current data suggest that its diagnosis is often missed, with underuse of tryptase measurement; its treatment is delayed, with little use of epinephrine; and its underlying cause or causes are poorly investigated. Deaths from anaphylaxis are difficult to investigate because of miscoding. Surprisingly, patients treated with new and powerful chemotherapy agents and humanized mAbs present with nonclassical symptoms of anaphylaxis, and patients may present with unrecognized clonal mast cell disorders with KIT mutations may present as Hymenoptera-induced or idiopathic anaphylaxis. The goal of this review is to recognize the presentations of anaphylaxis with the description of its current phenotypes, to provide new insight and understanding of its mechanisms and causes through its endotypes, and to address its biomarkers for broad clinical use. Ultimately, the aim is to empower allergists and heath care providers with new tools that can help alleviate patients' symptoms, preventing and protecting them against anaphylaxis.
过敏反应是最严重和最可怕的过敏反应，使患者处于高风险状态，并要求医疗保健提供者迅速识别和立即管理。然而，由于其症状模仿其他疾病，如哮喘和荨麻疹，目前的数据表明，其诊断经常被忽视，对类胰蛋白酶测量的使用不足；其治疗被延迟，很少使用肾上腺素；其根本原因或原因也未得到充分调查。由于误编码，过敏反应导致的死亡难以调查。令人惊讶的是，接受新型和强大化疗药物和人源化单克隆抗体治疗的患者表现出非典型过敏反应症状，并且可能表现出未被识别的克隆肥大细胞疾病，伴有 KIT 突变，可能表现为蜂类诱导或特发性过敏反应。本综述的目的是通过描述其当前表型来识别过敏反应的表现，通过其内型提供对其机制和原因的新见解和理解，并解决其广泛临床应用的生物标志物。最终，目的是为过敏症专家和医疗保健提供者提供新工具，帮助缓解患者的症状，预防和保护他们免受过敏反应的影响。
