Kemp S F, Lockey R F, Wolf B L, Lieberman P
Department of Internal Medicine, University of Tennessee College of Medicine, Memphis, USA.
Arch Intern Med. 1995 Sep 11;155(16):1749-54. doi: 10.1001/archinte.155.16.1749.
A presentation of findings from a large population of anaphylaxis cases.
Retrospective chart review and follow-up questionnaire provided data on 266 subjects (113 males and 153 females) aged 12 to 75 years (mean age, 38 years) who were referred to a university-affiliated private allergy-immunology practice in Memphis, Tenn, for evaluation and management of anaphylaxis from January 1978 through March 1992.
Of 266 subjects, 162 (61%) had three or more anaphylactic episodes, 41 (15%) had two episodes, and 63 (24%) had one episode. Atopy was present in 98 individuals (37%). Physicians thought foods, spices, and food additives caused anaphylaxis in 89 individuals (34%); crustaceans and peanut accounted for about half of these cases. Medications were thought to have caused the anaphylactic episodes in 52 individuals (20%); nonsteroidal anti-inflammatory drugs in about half of these cases. Other probable causes included exercise (n = 19), latex (n = 2), hormonal changes (n = 2), and insect bites (n = 4). A suspected cause could not be determined in 98 individuals (37%). These subjects were diagnosed as having idiopathic anaphylaxis. Of the 266 subjects, 102 responded to a follow-up survey; 68 (67%) of the 102 were thought to have identifiable causes of anaphylaxis (32 of whom [47%] failed to carry epinephrine syringes for self-administration despite instructions to do so). In contrast, of 34 subjects with idiopathic anaphylaxis who responded to the survey, only three (9%) did not carry epinephrine.
(1) Atopy is common in subjects who experience anaphylaxis, regardless of its origin; (2) crustaceans and nonsteroidal anti-inflammatory drugs are the most common food and medication groups, respectively, thought to cause anaphylaxis; (3) causative agents can be identified for two thirds of the subjects, and recurrent attacks are the rule; and (4) subjects with idiopathic anaphylaxis are more likely to carry epinephrine for self-administration than those with identifiable causes.
大量过敏反应病例的研究结果呈现。
通过回顾性病历审查和随访问卷，收集了1978年1月至1992年3月期间转诊至田纳西州孟菲斯市一家大学附属私立过敏免疫诊所进行过敏反应评估和管理的266名受试者（113名男性和153名女性）的数据，这些受试者年龄在12至75岁之间（平均年龄38岁）。
在266名受试者中，162名（61%）有三次或更多次过敏反应发作，41名（15%）有两次发作，63名（24%）有一次发作。98名个体（37%）存在特应性。医生认为食物、香料和食品添加剂导致89名个体（34%）发生过敏反应；其中约一半病例由甲壳类动物和花生引起。52名个体（20%）的过敏反应发作被认为是由药物引起的；其中约一半病例由非甾体类抗炎药引起。其他可能的原因包括运动（n = 19）、乳胶（n = 2）、激素变化（n = 2）和昆虫叮咬（n = 4）。98名个体（37%）无法确定可疑病因。这些受试者被诊断为特发性过敏反应。在266名受试者中，102名回复了随访调查；102名中的68名（67%）被认为有可识别的过敏反应病因（其中32名[47%]尽管被告知要携带肾上腺素注射器用于自我注射，但并未携带）。相比之下，在回复调查的34名特发性过敏反应受试者中，只有3名（9%）没有携带肾上腺素。
（1）过敏反应患者中特应性很常见，无论其病因如何；（2）甲壳类动物和非甾体类抗炎药分别是最常见的被认为可导致过敏反应的食物和药物类别；（3）三分之二的受试者可确定病因，且复发发作很常见；（4）与有可识别病因的受试者相比，特发性过敏反应受试者更有可能携带肾上腺素用于自我注射。
