Umetsu D T, Hahn J S, Perez-Atayde A R, Geha R S
J Allergy Clin Immunol. 1985 Nov;76(5):713-8. doi: 10.1016/0091-6749(85)90676-1.
An 8-year-old boy developed anaphylaxis after receiving his maintenance dose of immunotherapy and proceeded to display the signs and symptoms of serum sickness. These consisted of fever, arthralgia, arthritis, urticaria followed by a hemorrhagic palpable rash, edema, lymphadenopathy, splenomegaly, abdominal pain, proteinuria, and neurologic manifestations consistent with vascular compromise of the posterior cerebral circulation. A skin biopsy specimen revealed perivascular infiltrates of lymphocytes and few polymorphonuclear neutrophils. The timing of events in this patient suggests that immunotherapy initiated a chain of events beginning with anaphylaxis and leading to serum sickness. It is hypothesized that the enhanced vascular permeability that accompanied the anaphylaxis allowed immune complexes that may have preexisted in the circulation to deposit in the blood vessels of the patient. These complexes may or may not have been related to the immunotherapy itself. Because antihistamines are known to prevent the induction of serum sickness, early and aggressive treatment of anaphylaxis during immunotherapy may prevent the occurrence of immune complex disease.
一名8岁男孩在接受维持剂量的免疫治疗后发生过敏反应，随后出现血清病的体征和症状。这些症状包括发热、关节痛、关节炎、荨麻疹，随后出现可触及的出血性皮疹、水肿、淋巴结病、脾肿大、腹痛、蛋白尿以及与大脑后循环血管受损一致的神经表现。皮肤活检标本显示血管周围有淋巴细胞浸润，并有少量多形核中性粒细胞。该患者事件的发生时间表明，免疫治疗引发了一系列事件，始于过敏反应并导致血清病。据推测，过敏反应伴随的血管通透性增强使得循环中可能预先存在的免疫复合物沉积在患者的血管中。这些复合物可能与免疫治疗本身有关，也可能无关。由于已知抗组胺药可预防血清病的诱发，因此在免疫治疗期间早期积极治疗过敏反应可能预防免疫复合物疾病的发生。
