Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001
Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001
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DOI：
10.1016/j.jaci.2004.02.006
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发表时间：
2004-06-01
影响因子：
14.2
通讯作者：
Liss, GM
中科院分区：
文献类型：
--
作者：
Bernstein, DI;Wanner, M;Liss, GM
背景资料：自1989年以来，在北美没有调查过与皮肤试验和注射免疫疗法相关的致命反应。目的：在美国过敏、哮喘和免疫学学会的成员诊所中，对1990年至2001年发生的与皮肤试验和免疫疗法相关的致命反应和近乎致命的免疫疗法反应进行了调查。一个简短的调查，致命的反应被发送到所有美国过敏，哮喘和免疫学医师学会，和87个项目的后续详细的调查问卷被发送到那些报告致命reactions.Results：2404名成员，646（25%）回答了简短的调查。有20例致死性免疫治疗反应由当地医生直接报告，21例由当地医生间接报告。有273例（占响应样本的42%）报告了近乎致命的反应。据估计，每250万次注射中就有1次发生致命反应，平均每年有3.4人死亡。一个死亡后，证实皮肤点刺试验与多种食物过敏原。在长问卷调查中描述的17例死亡病例中，15例为哮喘患者，其大多数症状未得到最佳控制。3例反应发生在无医学监督的环境中。没有人接受β受体阻滞剂，一人正在服用血管紧张素转换酶抑制剂。大多数致死性反应（59%）发生在维持过敏原剂量时。3例反应在注射后超过30分钟开始发作，开始肾上腺素治疗显著延迟。肾上腺素没有管理在3其他致命reactors.Conclusions：致命的免疫治疗注射反应发生在以前的调查中报道的类似的利率。某些临床实践得到改善（即，排除β受体阻滞剂），给药错误不常见。免疫治疗的致命反应通常发生在不适合最佳治疗过敏反应的环境中。严格遵守实践指南可能会防止或减少未来的致命反应。
Background: Fatal reactions associated with skin testing and injection immunotherapy have not been surveyed in North America since 1989.Objective: A survey of fatal reactions related to skin testing and immunotherapy and of near-fatal immunotherapy reactions that transpired from 1990 through 2001 was conducted among member practices of the American Academy of Allergy, Asthma and Immunology.Methods: A short survey of fatal reactions was sent to all American Academy of Allergy, Asthma and Immunology physicians, and an 87-item follow-up detailed questionnaire was sent to those reporting fatal reactions.Results: Of 2404 members, 646 (25%) responded to the short survey. There were 20 fatal immunotherapy reactions that were directly reported and 21 indirectly reported cases by local physicians. There were 273 (42% of the responding sample) reports of near-fatal reactions. It was estimated that fatal reactions occurred every 1 per 2.5 million injections, with an average of 3.4 deaths per year. One fatality was confirmed after skin prick testing with multiple food allergens. Of 17 fatal deaths described in long questionnaires, 15 were in asthmatic patients, the majority of whose symptoms were not optimally controlled. Three reactions occurred in a medically unsupervised setting. None were receiving beta-blockers, and one was taking an angiotensin-converting enzyme inhibitor. Most fatal reactions (59%) occurred with maintenance allergen doses. The onset of 3 reactions began more than 30 minutes after injections, with a significant delay in starting epinephrine. Epinephrine was not administered in 3 other fatal reactors.Conclusions: Fatal reactions to immunotherapy injections occurred at similar rates reported in previous surveys. Certain clinical practices have improved (ie, exclusion of beta-blockers), and dosing errors were infrequent. Fatal reactions to immunotherapy often occur in settings inappropriate for optimal treatment of anaphylaxis. Strict adherence to practice guidelines might prevent or minimize future fatal reactions.