Vinuya R Z, Simon M R, Schwartz L B
Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
Ann Allergy. 1994 Sep;73(3):232-4.
Anaphylactic reactions usually occur seconds to minutes after exposure to the relevant antigen. Late onset, biphasic, and protracted anaphylaxis also occur. The incidence of prolonged responses is unknown, but may be common. In all nonfood-related cases, levels of tryptase were not measured during protracted episodes. Tryptase has been shown to be a useful specific indicator of mast cell involvement in anaphylaxis.
To determine whether mast cell activation, as demonstrated by elevated serum tryptase concentrations, can occur in protracted anaphylaxis.
Case report; serum tryptase concentrations were measured by radioimmunoassay.
A 33-year-old white man developed hives three days prior to admission. The next day, vomiting, abdominal cramps and bloating, lower lip swelling, wheezing, and a feeling of tightness over his throat and chest were experienced. The gastrointestinal symptoms continued until his hospital admission. One day prior to admission, he developed transient lightheadedness. On admission he had generalized urticaria and abdominal tenderness. Blood pressure of 115/58 mm/Hg rose to 180/60 and heart rate fell from 107/min to 90/min following 2.2 L of intravenous fluids. Serum tryptase levels were elevated at 7.2 ng/mL and 5.1 ng/mL on the first and second hospital days (fourth and fifth days of symptoms). Serum tryptase was < 1.0 ng/mL 5 months later.
The elevated serum tryptase levels at 96 and 120 hours following the onset of symptoms strongly suggest that continued mast cell degranulation can occur during protracted anaphylaxis. This strengthens the argument that mast cell activation is important in the pathophysiology of protracted anaphylaxis.
过敏反应通常在接触相关抗原后数秒至数分钟内发生。迟发性、双相性和持续性过敏反应也会出现。持续性反应的发生率尚不清楚，但可能很常见。在所有与食物无关的病例中，持续性发作期间未检测类胰蛋白酶水平。类胰蛋白酶已被证明是肥大细胞参与过敏反应的一种有用的特异性指标。
确定血清类胰蛋白酶浓度升高所表明的肥大细胞激活是否会在持续性过敏反应中发生。
病例报告；通过放射免疫测定法测量血清类胰蛋白酶浓度。
一名33岁白人男性在入院前三天出现荨麻疹。第二天，出现呕吐、腹部绞痛和腹胀、下唇肿胀、喘息以及喉咙和胸部的紧绷感。胃肠道症状持续到他入院。入院前一天，他出现短暂的头晕。入院时，他全身荨麻疹且腹部压痛。静脉输注2.2升液体后，血压从115/58毫米汞柱升至180/60，心率从107次/分钟降至90次/分钟。在住院的第一天和第二天（症状出现的第四天和第五天），血清类胰蛋白酶水平升高至7.2纳克/毫升和5.1纳克/毫升。5个月后血清类胰蛋白酶<1.0纳克/毫升。
症状出现后96和120小时血清类胰蛋白酶水平升高强烈提示持续性过敏反应期间肥大细胞可继续脱颗粒。这进一步证明肥大细胞激活在持续性过敏反应的病理生理学中很重要。
