Elevated serum cytokines during human anaphylaxis: Identification of potential mediators of acute allergic reactions
Elevated serum cytokines during human anaphylaxis: Identification of potential mediators of acute allergic reactions
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DOI：
10.1016/j.jaci.2009.07.055
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发表时间：
2009-10-01
影响因子：
14.2
通讯作者：
Brown, Simon G. A.
中科院分区：
文献类型：
--
作者：
Stone, Shelley F.;Cotterell, Claire;Brown, Simon G. A.
背景：过敏反应通常是不可预见的，需要紧急处理。因此，在人类的生物介质一直难以界定。目的：我们的目的是确定细胞因子和趋化因子的浓度增加，在人类过敏反应，并确定如何每一个与严重程度。方法：我们测量了潜在介质的浓度，包括细胞因子、趋化因子、肥大细胞类胰蛋白酶（MCT）和组胺，在急诊科就诊的76名过敏反应患者中，在3个时间点以上，将这些与总体严重程度量表、低血压和缺氧相关。IL-2、IL-6、IL-10、TNF受体1、MCT，与中度反应（n = 40）和健康对照组相比，重度反应患者（n = 36）的组胺和组胺显著升高。组胺水平在急诊到达时达到峰值，而其他介质达到峰值后。与健康对照组相比，重度反应中IL-4、IL-5、IL-13、IFN-γ和TNF-α略微升高，但与反应严重程度无关。重度反应倾向于水肿（n = 19）或低氧血症（n = 12）。IL-6、IL-10、TNF受体1、MCT和组胺水平与低血压相关。没有介质与低氧血症或其他呼吸功能。结论：本研究证实，一些细胞因子的浓度升高，在人类过敏反应的血液中，有些与低血压的存在。其他仅在现有检测方法无法可靠检测的浓度范围内轻微升高。在呼吸反应期间，介质可能主要局限于气道，因此血液浓度不反映活动。（J Allergy Clin Immunol 2009;124：786-92.）
Background: Anaphylaxis is generally unanticipated and requires emergency management. Therefore, the biological mediators in human beings have been difficult to define.Objective: Our aim was to identify cytokines and chemokines whose concentrations increase during anaphylaxis in human beings and to determine how each correlates with severity.Methods: We measured the concentrations of potential mediators, including cytokines, chemokines, mast cell tryptase (MCT), and histamine, over 3 time points in 76 patients presenting to emergency departments with anaphylaxis and correlated these with a global severity scale, hypotension, and hypoxia.Results: IL-2, IL-6, IL-10, TNF receptor 1, MCT, and histamine were significantly elevated in patients with severe reactions (n = 36) compared with moderate reactions (n = 40) and healthy controls. Histamine levels peaked at emergency department arrival, whereas other mediators peaked later. IL-4, IL-5, IL-13, IFN-gamma, and TNF-alpha were marginally elevated in severe reactions compared with healthy controls but did not correlate with reaction severity. Severe reactions tended to be either hypotensive (n = 19) or hypoxemic (n = 12). Levels of IL-6, IL-10, TNF receptor 1, MCT, and histamine correlated with hypotension. No mediator correlated with hypoxemia or other respiratory features.Conclusion: This study confirms that the concentrations of a number of cytokines are elevated in blood during anaphylaxis in human beings and that some correlate with the presence of hypotension. Others were only marginally elevated within a concentration range that available assays do not reliably detect. During respiratory reactions, mediators may be largely confined to the airways so that blood concentrations do not reflect activity. (J Allergy Clin Immunol 2009;124:786-92.)