Smeding C, van Iterson M, Gamadia L E, Innemee G, Heidt J
St. Antonius Ziekenhuis, afd. Anesthesiologie, Nieuwegein.
Tergooi, afd. Interne Geneeskunde, Nefrologie en Allergologie, Hilversum/Blaricum.
Ned Tijdschr Geneeskd. 2020 Nov 12;164:D4990.
Wasp and bee stings can lead to allergic reactions, anaphylaxis, Kounis syndrome, toxicity, organ failure and, in rare cases, cardiac arrest. In the Netherlands, fatal complications as a result of wasp or bee stings are rare; here we describe three recent severe cases. We diagnosed two patients with anaphylactic shock due to multiple wasp stings, resulting in cardiac arrest and death. Taking the number of stings (> 100) in one of these cases into account, a differential diagnostic consideration was 'exogenic toxic shock'. Considering the severe reaction with fatal outcome in both patients we cannot rule out the existence of indolent mastocytosis. The third patient developed grade 1 anaphylaxis and severe facial swelling, but survived. In this article we describe the pathophysiological background, treatment, diagnostics and desensitisation therapy.
黄蜂和蜜蜂蜇伤可导致过敏反应、过敏症、库尼斯综合征、中毒、器官衰竭，在极少数情况下还会导致心脏骤停。在荷兰，黄蜂或蜜蜂蜇伤导致的致命并发症很少见；在此我们描述三例近期的严重病例。我们诊断出两名患者因多次黄蜂蜇伤而发生过敏性休克，导致心脏骤停和死亡。考虑到其中一例患者的蜇伤次数（>100次），鉴别诊断考虑为“外源性中毒性休克”。鉴于两名患者均出现严重反应并导致死亡，我们不能排除惰性肥大细胞增多症的存在。第三名患者发生1级过敏反应和严重面部肿胀，但存活下来。在本文中，我们描述了病理生理背景、治疗、诊断和脱敏治疗。
