Lessons for management of anaphylaxis from a study of fatal reactions
Lessons for management of anaphylaxis from a study of fatal reactions
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DOI：
10.1046/j.1365-2222.2000.00864.x
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发表时间：
2000-08-01
影响因子：
6.1
通讯作者：
Pumphrey, RSH
中科院分区：
文献类型：
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作者：
Pumphrey, RSH
背景：不可预测的过敏反应和需要立即，往往临时治疗将使对照试验不可行；因此，必须使用其他手段来确定最佳管理。目的本研究旨在探讨致死性过敏反应的情况。方法建立一个登记册，包括自1992年以来在英国所有致命的过敏反应，可以追溯到证实的死亡原因。从其他来源获得的数据表明，由于过敏反应而证实的死亡低估了真实发生率。所有病例均需详细了解既往病史、反应和尸检。结果在英国每年记录的20例致命反应中，约有一半是医源性的，四分之一是由食物或昆虫毒液引起的。所有被认为是由食物引起的致命反应都会导致呼吸困难，86%的人会导致呼吸停止；休克在医源性和毒液反应中更为常见。食物引起呼吸或心脏骤停的中位时间为30分钟，毒液为15分钟，医源性反应为5分钟。28%的死亡病例复苏，但在3 -30天后死亡，主要死于缺氧脑损伤。肾上腺素（肾上腺素）用于治疗62%的致命反应，但在停搏前仅用于治疗14%。结论及时发现过敏反应、早期使用肾上腺素、吸入β受体激动剂等措施是治疗成功的关键。然而，无论给予何种治疗，一些反应都是致命的；因此，过敏反应的最佳管理是尽可能避免病因。致命反应的原因和先前的反应之间可预测的交叉反应被忽视了。肾上腺素过量至少造成三人死亡必须避免由于各种原因，用于自我治疗的试剂盒被证明是无用的；它的成功取决于选择适当的药物、易于使用和良好的培训。
Background The unpredictability of anaphylactic reactions and the need for immediate, often improvised treatment will make controlled trials impracticable; other means must therefore be used to determine optimal management.Objectives This study aimed to investigate the circumstances leading to fatal anaphylaxis.Methods A register was established including all fatal anaphylactic reactions in the UK since 1992 that could be traced from the certified cause of death. Data obtained from other sources suggested that deaths certified as due to anaphylaxis underestimate the true incidence. Details of the previous medical history, the reaction and necropsy were sought for all cases.Results Approximately half the 20 fatal reactions recorded each year in the UK were iatrogenic, and a quarter each due to food or insect venom. All fatal reactions thought to have been due to food caused difficulty breathing that in 86% led to respiratory arrest; shock was more common in iatrogenic and venom reactions. The median time to respiratory or cardiac arrest was 30 min for foods, 15 min for venom and 5 min for iatrogenic reactions. Twenty-eight per cent of fatal cases were resuscitated but died 3 h-30 days later, mostly from hypoxic brain damage. Adrenaline (epinephrine) was used in treatment of 62% of fatal reactions but before arrest in only 14%.Conclusions Immediate recognition of anaphylaxis, early use of adrenaline, inhaled beta agonists and other measures are crucial for successful treatment. Nevertheless, a few reactions will be fatal whatever treatment is given; optimal management of anaphylaxis is therefore avoidance of the cause whenever this is possible. Predictable cross-reactivity between the cause of the fatal reaction and that of previous reactions had been overlooked. Adrenaline overdose caused at least three deaths and must be avoided. Kit for self-treatment had proved unhelpful for a variety of reasons; its success depends on selection of appropriate medication, ease of use and good training.