Anaphylaxis: Clinical patterns, mediator release, and severity
Anaphylaxis: Clinical patterns, mediator release, and severity
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DOI：
10.1016/j.jaci.2013.06.015
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发表时间：
2013-11-01
影响因子：
14.2
通讯作者：
Isbister, Geoffrey K.
中科院分区：
文献类型：
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作者：
Brown, Simon G. A.;Stone, Shelley F.;Isbister, Geoffrey K.
背景：人类对过敏反应及其机制的前瞻性研究一直很有限，严重病例很少，或只检查一到两种介质。目的：我们希望确定过敏反应的临床类型以及介质与严重程度之间的关系。方法：收集治疗过程中和出院前的数据。连续采血检测肥大细胞类胰蛋白酶、组胺、过敏性毒素(C3a、C4a、C5a)、细胞因子(IL-2、IL-6、IL-10)、可溶性肿瘤坏死因子受体I、血小板活化因子乙酰水解酶。主成分分析确定了中介模式，Logistic回归分析确定了与反应严重程度和延迟反应相关的危险因素和中介模式。结果：在402人的412个反应中，315个符合国家过敏和传染病研究所/食物过敏和过敏反应网络对过敏反应的定义。在97例严重反应中，45例(46%)为低血压，23例(24%)为低氧血症，29例(30%)为混合性反应。一名患者死亡。严重反应与高龄、既往肺部疾病和药物引起有关。在315例过敏反应中，29例(9.2%)出现肾上腺素治疗的延迟性恶化，在低血压反应和既往肺部疾病后更为常见。在29例延迟性恶化中，22例(76%)发生在最初肾上腺素治疗后的4小时内。在其余7例中，2例严重，发生在最初的严重反应后，10小时内。所有介质均与病情严重程度相关，1组(肥大细胞类胰蛋白酶、组胺、IL-6、IL-10和肿瘤坏死因子受体I)也与延迟恶化有关。低活性的血小板活化因子乙酰水解酶活性与严重反应有关。结论：多条炎症途径驱动了反应的严重程度，并支持初步治疗后安全观察期的建议。
Background: Prospective human studies of anaphylaxis and its mechanisms have been limited, with few severe cases or examining only 1 or 2 mediators.Objectives: We wanted to define the clinical patterns of anaphylaxis and relationships between mediators and severity.Methods: Data were collected during treatment and before discharge. Serial blood samples were taken for assays of mast cell tryptase, histamine, anaphylatoxins (C3a, C4a, C5a), cytokines (IL-2, IL-6, IL-10), soluble tumor necrosis factor receptor I, and platelet activating factor acetyl hydrolase. Principal component analysis defined mediator patterns, and logistic regression identified risk factors and mediator patterns associated with reaction severity and delayed reactions.Results: Of 412 reactions in 402 people, 315 met the definition for anaphylaxis by the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network. Of 97 severe reactions 45 (46%) were hypotensive, 23 (24%) were hypoxemic, and 29 (30%) were mixed. One patient died. Severe reactions were associated with older age, pre-existing lung disease, and drug causation. Delayed deteriorations treated with epinephrine occurred in 29 of 315 anaphylaxis cases (9.2%) and were more common after hypotensive reactions and with preexisting lung disease. Twenty-two of the 29 delayed deteriorations (76%) occurred within 4 hours of initial epinephrine treatment. Of the remaining 7 cases, 2 were severe and occurred after initially severe reactions, within 10 hours. All mediators were associated with severity, and 1 group (mast cell tryptase, histamine, IL-6, IL-10, and tumor necrosis factor receptor I) was also associated with delayed deteriorations. Low platelet activating factor acetyl hydrolase activity was associated with severe reactions.Conclusion: The results suggest that multiple inflammatory pathways drive reaction severity and support recommendations for safe observation periods after initial treatment.