van der Linden P W, Struyvenberg A, Kraaijenhagen R J, Hack C E, van der Zwan J K
Eemland Hospital, Amersfoort, The Netherlands.
Ann Intern Med. 1993 Feb 1;118(3):161-8. doi: 10.7326/0003-4819-118-3-199302010-00001.
To study the rate and severity of anaphylactic reaction in relation to plasma levels of cardiovascular mediators in persons with a history of insect-sting anaphylactic shock who were rechallenged with a sting by the same insect.
A cohort study with measurements before and after intentional sting challenge.
Intensive care unit of an 830-bed general hospital, a national center of insect-sting anaphylaxis in The Netherlands.
A total of 138 patients referred after a previous anaphylactic reaction to a Hymenoptera sting; and 8 volunteers.
Signs of anaphylaxis and plasma levels of catecholamines and angiotensins.
Only 39 of 138 (28%) of patients with a previous insect-sting anaphylactic reaction developed anaphylactic symptoms after sting challenge. Values of cardiovascular mediators and mean arterial pressure did not differ after the challenge from initial values in the volunteers or in the patients with a mild or no reaction after challenge. In the 17 patients with anaphylactic shock, mean arterial pressure decreased from 97 +/- 11 (mean +/- SD) to 65 +/- 17 mm Hg (P < 0.001), epinephrine levels rose from a median of 0.3 nmol/L (range, 0.2 to 2.3 nmol/L) to 2.5 nmol/L (0.2 to 35.7 nmol/L; P < 0.05), norepinephrine from 1.5 nmol/L (0.5 to 6.7) to 5.9 nmol/L (1.6 to 30.9 nmol/L; P < 0.01), and angiotensin II from 61 pmol/L (7 to 217 pmol/L) to 105 pmol/L (11 to 286 pmol/L; P < 0.01), all within 5 minutes after the onset of anaphylactic symptoms. The rise of these mediators correlated with the drop in blood pressure (P < 0.001). Dopamine and angiotensin I levels did not change in any participants.
A recurrent insect-sting anaphylactic reaction occurred in only 28% of patients with a previous reaction. During this recurrent reaction, plasma levels of endogenous epinephrine, norepinephrine, and angiotensin II rose in relation to hypotension.
研究有昆虫叮咬所致过敏性休克病史的患者，在再次被同一种昆虫叮咬后，过敏反应的发生率及严重程度与心血管介质血浆水平的关系。
一项在故意进行叮咬激发前后进行测量的队列研究。
一家拥有830张床位的综合医院的重症监护病房，荷兰全国昆虫叮咬过敏反应中心。
共有138名先前对膜翅目昆虫叮咬有过过敏反应的患者转诊而来；以及8名志愿者。
过敏反应体征以及儿茶酚胺和血管紧张素的血浆水平。
138名曾有昆虫叮咬过敏反应的患者中，只有39名（28%）在叮咬激发后出现过敏症状。激发后，志愿者以及激发后反应轻微或无反应的患者的心血管介质值和平均动脉压与初始值相比无差异。在17名过敏性休克患者中，平均动脉压从97±11（均值±标准差）降至65±17 mmHg（P<0.001），肾上腺素水平从中位数0.3 nmol/L（范围0.2至2.3 nmol/L）升至2.5 nmol/L（0.2至35.7 nmol/L；P<0.05），去甲肾上腺素从1.5 nmol/L（0.5至6.7）升至5.9 nmol/L（1.6至30.9 nmol/L；P<0.01），血管紧张素II从61 pmol/L（7至217 pmol/L）升至105 pmol/L（11至286 pmol/L；P<0.01），所有这些变化均在过敏症状出现后的5分钟内发生。这些介质的升高与血压下降相关（P<0.001）。多巴胺和血管紧张素I水平在任何参与者中均未发生变化。
曾有过过敏反应的患者中，只有28%出现复发性昆虫叮咬过敏反应。在这种复发性反应期间，内源性肾上腺素、去甲肾上腺素和血管紧张素II的血浆水平随低血压而升高。
