de Weck A L
Institute for Clinical Immunology, Bern, Switzerland.
Ann Fr Anesth Reanim. 1993;12(2):126-30. doi: 10.1016/s0750-7658(05)81021-4.
The main compounds causing anaphylactic reactions in anaesthesia are myorelaxants, opiate or barbiturate derivatives or natural allergens (latex). While the latex-derived allergens are of sizeable molecular weight and behave as regular complete allergens, most of the other compounds are low molecular weight molecules behaving as incomplete allergens or haptens. For these, the sensitization process usually encompasses direct reaction (conjugation) with cellular surface proteins (e.g. histocompatibility antigens) of an antigen-presenting cells and ensuing formation of hapten-specific IgE antibodies. Since many patients experience igE-mediated anaphylactic reactions upon first contact with a myorelaxant, a previous latent sensitivity to some cross-reactive epitope (e.g. quaternary ammonium group) must be postulated. In sensitized individuals possessing drug-specific IgE antibodies, the elicitation of anaphylactic reactions classically requires bridging on the surface of IgE loaded mast cells/basophils by allergens which are functionally at least bivalent (two or more reactive epitopes by allergen molecule). In some cases, myorelaxant molecules, chemically appearing as mirror molecules may be functionally bivalent and elicit anaphylactic reactions apparently directly. In most instances, however, when the responsible drug only contains one reactive epitope per molecule, alternative mechanisms and rapid formation of functionally polyvalent drug allergens in tissue have to be postulated in order to explain the rapid elicitation of anaphylactic reactions by molecules which appear to be immunologically monovalent in vitro. Indeed, in most instances, monovalent haptens and drugs appear to be inhibitors rather than elicitors of IgE-mediated reactions.
麻醉中引起过敏反应的主要化合物是肌松药、阿片类或巴比妥类衍生物或天然过敏原（乳胶）。虽然乳胶衍生的过敏原分子量较大，表现为典型的完全过敏原，但大多数其他化合物是低分子量分子，表现为不完全过敏原或半抗原。对于这些物质，致敏过程通常包括与抗原呈递细胞的细胞表面蛋白（如组织相容性抗原）直接反应（结合），随后形成半抗原特异性IgE抗体。由于许多患者在首次接触肌松药时就会发生IgE介导的过敏反应，因此必须假定先前对某些交叉反应表位（如季铵基团）存在潜在敏感性。在拥有药物特异性IgE抗体的致敏个体中，过敏反应的引发通常需要过敏原在负载IgE的肥大细胞/嗜碱性粒细胞表面进行交联，这些过敏原在功能上至少是二价的（每个过敏原分子有两个或更多反应性表位）。在某些情况下，化学上看似镜像分子的肌松药分子在功能上可能是二价的，并明显直接引发过敏反应。然而，在大多数情况下，当致病药物每个分子仅含有一个反应性表位时，为了解释在体外看似免疫单价的分子能快速引发过敏反应，必须假定存在替代机制以及组织中功能多价药物过敏原的快速形成。事实上，在大多数情况下，单价半抗原和药物似乎是IgE介导反应的抑制剂而非引发剂。
