Pumphrey R S, Stanworth S J
Department of Immunology, Central Manchester Trust Hospitals, UK.
Clin Exp Allergy. 1996 Dec;26(12):1364-70.
To assess the clinical spectrum of anaphylaxis with a view to developing management guidelines and as a foundation for an epidemiological study.
Study of the reaction histories and investigations of 172 patients, including children and adults, referred because of anaphylactic reactions.
Over 700 reactions occurred in 172 patients from age 5 months to 69 years. There were equal numbers of males and females; when ranked by age at worst reaction, the youngest quartile (0-4 years) was 75% male and the oldest quartile (40+ years) was 74% female. The severity of reactions graded continuously from fatal to mild One hundred and twenty of 172 had two or more reactions; the worst reaction was the first in 33, midsequence in 35 and the most recent in 52. Suspected causes of each patient's worst reaction associated with positive allergy tests include peanuts (42), tree nuts (23), other foods (25, in five associated with exercise), venoms (six bee, 22 wasp), muscle relaxants (seven) and latex (six). Twenty were classified as idiopathic and, in a further 13, investigation of the suspected cause proved negative. There was doubt about the nature of some of the 'reactions' reported even though these had been treated as for anaphylactic reactions.
The clinical spectrum of anaphylaxis has been defined for the area served by our unit. Management guidelines and future epidemiological studies will have to address the continuous distribution of severity of reactions, the wide age range and the multiplicity of causes.
评估过敏反应的临床谱，以期制定管理指南并作为流行病学研究的基础。
对172例因过敏反应前来就诊的患者（包括儿童和成人）的反应病史进行研究并开展调查。
172例患者年龄从5个月至69岁，共发生700多次过敏反应。男女患者数量相等；按最严重反应时的年龄排序，最年轻的四分位数区间（0 - 4岁）男性占75%，最年长的四分位数区间（40岁及以上）女性占74%。反应严重程度从致命到轻微呈连续分级。172例患者中有120例发生过两次或更多次过敏反应；最严重的反应首次发生的有33例，发生在中间时段的有35例，最近发生的有52例。与阳性过敏试验相关的每位患者最严重反应的疑似病因包括花生（42例）、坚果（23例）、其他食物（25例，其中5例与运动有关）、毒液（6例蜜蜂，22例黄蜂）、肌肉松弛剂（7例）和乳胶（6例）。20例被归类为特发性，另有13例对疑似病因的调查结果为阴性。尽管一些报告的“反应”已按过敏反应进行治疗，但对其性质仍存疑问。
已明确了本单位服务区域内过敏反应的临床谱。管理指南和未来的流行病学研究将必须应对反应严重程度的连续分布、广泛的年龄范围以及多种病因。
