Poulsen Lars K, Jensen Bettina M, Esteban Vanesa, Garvey Lene Heise
Allergy Clinic, Copenhagen University Hospital at Gentofte, Hellerup, Denmark.
Immuno-Allergy Laboratory, Department of Immunology, IIS Fundación Jiménez Díaz, Madrid, Spain.
Front Immunol. 2017 Aug 10;8:871. doi: 10.3389/fimmu.2017.00871. eCollection 2017.
Anaphylaxis in humans is inherently difficult to study due to the acuteness of symptoms and the lack of biomarkers serving as risk predictors. Most cases are related to IgE sensitizations to foods, insect venoms, and drugs with mastocytosis patients forming a smaller risk group. However, identifying the relatively small fraction of persons at risk has been exceedingly difficult. In this review, we propose to describe anaphylaxis in a broader context than defined by IgE sensitization alone. Exposure to a trigger, such as an allergen, may lead to anaphylaxis, but in particular, the internal dose sensed by the immune system needs to be established. Moreover, intrinsic patient factors as well as the specific circumstances of the exposure, i.e., the extrinsic factors, need to be thoroughly accounted for. More controversially, other triggers of anaphylaxis, such as increased sensitivity to or reduced catabolism of histamine ("histamine intolerance") or mast cell activation syndrome also named mast cell activation disorder have been suggested, but still with very limited epidemiological evidence that a significant proportion of the observed reactions are caused by these alleged conditions. Thus, when all conditions are considered, it seems as if IgE-mediated reactions are responsible for the vast majority of anaphylactic conditions.
由于症状的急性发作以及缺乏作为风险预测指标的生物标志物，人类过敏反应本质上很难研究。大多数病例与对食物、昆虫毒液和药物的IgE致敏有关，肥大细胞增多症患者构成一个较小的风险群体。然而，识别出相对较小比例的有风险人群极其困难。在本综述中，我们建议在比仅由IgE致敏定义的更广泛背景下描述过敏反应。接触触发因素，如过敏原，可能会导致过敏反应，但特别需要确定免疫系统感知到的内部剂量。此外，还需要充分考虑患者的内在因素以及接触的具体情况，即外在因素。更具争议的是，有人提出过敏反应的其他触发因素，如对组胺的敏感性增加或组胺分解代谢减少（“组胺不耐受”）或肥大细胞活化综合征（也称为肥大细胞活化障碍），但仍然只有非常有限的流行病学证据表明观察到的反应中有很大一部分是由这些所谓的情况引起的。因此，综合考虑所有情况后，似乎IgE介导的反应是绝大多数过敏反应情况的原因。
