Clinical Approach Used in Medical Consultations for Allergic-Like Events Following Immunization: Case Series Report in Relation to Practice Guidelines
Clinical Approach Used in Medical Consultations for Allergic-Like Events Following Immunization: Case Series Report in Relation to Practice Guidelines
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DOI：
10.1016/j.jaip.2016.09.048
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发表时间：
2017-05-01
影响因子：
9.4
通讯作者：
Skowronski, Danuta M.
中科院分区：
文献类型：
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作者：
Zafack, Joseline G.;De Serres, Gaston;Skowronski, Danuta M.
背景：实践参数联合工作组(JTFPP)对免疫后出现过敏样事件(ALE)的患者进行调查和再免疫的指南是基于过敏反应的可能性，通过症状出现的时间(4小时)和涉及的系统数量进行评估。目的：本研究的目的是将一系列ALE患者的实际治疗与JTFPP指南进行比较，并讨论其使用中的关键概念和注意事项。方法：这项回顾研究基于对加拿大一家大型过敏科咨询疑似疫苗相关ALE的患者的图表回顾。结果：135名免疫后出现ALE的患者中只有3人因疑似过敏反应而被转介。无论出现症状的时间或ALE涉及的系统数量，患者的皮肤测试或重新免疫的频率都没有显着差异。8例首次ALE发生在免疫后1小时内，再次免疫后复发。另1例首次ALE发生在流感疫苗接种后10小时，出现咽喉紧绷和吞咽困难，无客观体征。结论：大多数接种后ALE不提示过敏反应，不应这样处理。JTFPP指南中对过敏反应的定义是非特定的，可能需要重新考虑。限制对起病为ALE的患者进行皮试和分级剂量再免疫
BACKGROUND: The Joint Task Force on Practice Parameters (JTFPP) guidelines for the investigation and reimmunization of patients who experienced allergic-like events (ALEs) after immunization are predicated on the likelihood of anaphylaxis, assessed through the time to symptom onset (4 hours) and number of systems involved.OBJECTIVE: The objectives of this study were to compare the management of a series of patients with ALE in actual practice relative to JTFPP guidelines and to discuss key concepts and considerations in their use.METHODS: This retrospective study was based on a chart review of patients who consulted for suspected vaccine-associated ALEs at a large allergy department in Canada.RESULTS: Only 3 of the 135 patients who presented ALEs after immunization were referred for suspected anaphylaxis. There was no significant difference in the frequency of skin testing or reimmunization of patients whatever the time to symptom onset or number of systems involved in the ALE. Eight patients whose initial ALE occurred within 1 hour after immunization had a recurrence on reimmunization. Another patient whose initial ALE occurred 10 hours after influenza immunization had throat tightening and difficulty swallowing without objective signs.CONCLUSIONS: Most ALEs after immunization are not suggestive of anaphylaxis and should not be managed as such. The definition of anaphylaxis in the JTFPP guidelines is nonspecific and may need to be revisited. Restricting skin testing and graded dose reimmunization to patients whose ALE onset is