INSECT-STING CHALLENGE IN 138 PATIENTS - RELATION BETWEEN CLINICAL SEVERITY OF ANAPHYLAXIS AND MAST-CELL ACTIVATION
INSECT-STING CHALLENGE IN 138 PATIENTS - RELATION BETWEEN CLINICAL SEVERITY OF ANAPHYLAXIS AND MAST-CELL ACTIVATION
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DOI：
10.1016/s0091-6749(06)80017-5
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发表时间：
1992-07-01
影响因子：
14.2
通讯作者：
VANDERZWAN, JK
中科院分区：
文献类型：
--
作者：
VANDERLINDEN, PWG;HACK, CE;VANDERZWAN, JK
138名之前对黄色夹克或蜜蜂叮咬有过敏反应的患者以及8名志愿者接受了院内叮咬挑战。研究了针刺过程中血浆组胺、胰蛋白酶和前列腺素D2 （PGD2）水平与临床症状的关系。攻毒前组胺、胰蛋白酶和PGD2水平（平均+/- SD）分别为2 +/- 1 nmol/L、0.3 +/- 0.3 U/L和320 +/- 223 ng/L。在志愿者中，除了一名无反应的患者外，这些水平在挑战后没有显着变化。相比之下，在18名轻度反应患者中，组胺和胰蛋白酶在刺激后的一个或多个时间点的平均升高是显著的。（5例患者组胺未升高，9例患者胰蛋白酶未升高。）除了一名患者的组胺水平外，从第一次过敏症状开始，所有17名发生严重反应的患者的组胺水平均显著升高。15分钟后，组胺含量达到峰值1275 +/- 2994 nmol/L（范围3 ~ 12800 nmol/L，中位数11 nmol/L），胰蛋白酶含量达到峰值406 +/- 1062 U/L（范围1.8 ~ 4400 U/L，中位数17 U/L）。这种水平的上升与平均动脉压呈负相关。严重反应患者的血浆PGD2水平与轻度或无反应患者的血浆PGD2水平无显著差异。总之，只有28%有膜翅虫过敏史的患者在住院后发生过敏反应。这些反应的临床严重程度与全身释放、预形成组胺和胰蛋白酶水平相关，但与PGD2水平无关。
One hundred thirty-eight patients with a previous anaphylactic reaction to a yellow jacket or a honeybee sting, as well as eight volunteers, were subjected to an in-hospital sting challenge. Plasma levels of histamine, tryptase, and prostaglandin D2 (PGD2) during sting challenge were studied in relation to clinical symptoms. Prechallenge levels (mean +/- SD) of histamine, tryptase, and PGD2 were 2 +/- 1 nmol/L, 0.3 +/- 0.3 U/L, and 320 +/- 223 ng/L, respectively. In the volunteers and in none except for one of the nonreacting patients, these levels did not change significantly after challenge. In contrast, mean increases in the group of 18 patients with a mild reaction were significant for histamine and tryptase at one or more time points after the challenge. (Five patients demonstrated no increase in histamine; nine demonstrated no increase in tryptase.) Except for histamine levels in one patient, these increases were considerably more in all 17 patients with a severe reaction, starting from the first anaphylactic symptoms. Fifteen minutes later, peak values were reached of 1275 +/- 2994 nmol of histamine per liter (range, 3 to 12800 nmol/L; median, 11 nmol/L) and 406 +/- 1062 U of tryptase per liter (range, 1.8 to 4400 U/L; median, 17 U/L). This rise in levels inversely correlated with the mean arterial pressure. Plasma levels of PGD2 in severely reacting patients did not differ significantly from those in patients with a mild or no reaction. In conclusion, only 28% of patients with a history of Hymenoptera anaphylaxis developed an anaphylactic reaction after an in-hospital challenge. The clinical severity of these reactions correlated with the level of systemically released, preformed histamine and tryptase, but not of PGD2.