van der Linden P W, Hack C E, Struyvenberg A, van der Zwan J K
Department of Internal Medicine, Utrecht University Hospital, The Netherlands.
J Allergy Clin Immunol. 1994 Aug;94(2 Pt 1):151-9. doi: 10.1016/0091-6749(94)90034-5.
Three hundred twenty-four patients with a history of yellow jacket- (n = 272) or honeybee- (n = 52) sting anaphylaxis were prospectively subjected to an in-hospital sting challenge. Plasma levels of specific IgE and IgG4, skin venom tests, severity of previous reaction, sex, age, atopic constitution, histamine skin test results, location and number of previous stings, time interval between previous anaphylactic reaction and sting challenge, and time interval between sting challenge and onset of anaphylaxis were studied in relation to the clinical severity of a reaction after sting challenge. A recurrent anaphylactic reaction after sting challenge was observed in 25% of yellow jacket- and in 52% of honeybee-sensitive persons. The severity of this reaction correlated significantly with age and the time interval between sting challenge and onset of anaphylaxis only: older persons with faster reactions had more severe symptoms after sting challenge. None of the current criteria for insect-sting hypersensitivity (IgE, IgG4, skin test) significantly related on an individual basis or in combinations to the reaction after sting challenge. We conclude that the current criteria to assess insect-venom hypersensitivity do not relate to the occurrence and severity of anaphylactic symptoms after an insect-sting challenge.
324例有黄蜂（n = 272）或蜜蜂（n = 52）蜇伤过敏史的患者接受了院内蜇伤激发试验。研究了特异性IgE和IgG4的血浆水平、皮肤毒液试验、既往反应的严重程度、性别、年龄、特应性体质、组胺皮肤试验结果、既往蜇伤的部位和次数、既往过敏反应与蜇伤激发试验之间的时间间隔，以及蜇伤激发试验与过敏反应发作之间的时间间隔与蜇伤激发试验后反应的临床严重程度的关系。在25%的黄蜂敏感者和52%的蜜蜂敏感者中观察到蜇伤激发试验后出现反复过敏反应。这种反应的严重程度仅与年龄以及蜇伤激发试验与过敏反应发作之间的时间间隔显著相关：反应较快的老年人在蜇伤激发试验后症状更严重。目前用于评估昆虫蜇伤超敏反应的标准（IgE、IgG4、皮肤试验），无论是单独还是联合使用，均与蜇伤激发试验后的反应无显著个体相关性。我们得出结论，目前评估昆虫毒液超敏反应的标准与昆虫蜇伤激发试验后过敏症状的发生和严重程度无关。
