Fatal Food Anaphylaxis: Distinguishing Fact From Fiction
Fatal Food Anaphylaxis: Distinguishing Fact From Fiction
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致命的食物过敏反应：区分事实与虚构
DOI：
10.1016/j.jaip.2021.10.008
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发表时间：
2022
期刊：
影响因子：
0.3
通讯作者：
Anagnostou A
中科院分区：
文献类型：
--
作者：
Anagnostou A
尽管人们普遍认为食物过敏的患病率正在增加，但支持这一观点的数据有限。食物是致命性过敏反应最不常见的原因，幸运的是，这种情况非常罕见。然而，这也是不可预测的。人们普遍认为，无法以有临床意义的方式预测严重反应。某些食物触发因素比其他触发因素更常与致命性过敏反应相关。在观察性研究中，花生和木本坚果至少占死亡人数的 30% 至 50%，海鲜和牛奶也与致命反应有关。致命的食物引起的过敏反应最有可能发生在青春期和成年早期，尽管其原因尚不清楚。国际指南一致认为，肌肉注射 (IM) 肾上腺素是治疗食物引发的过敏反应的首选治疗方法，并且通过 IM 途径给药具有良好的安全性。然而，尽管及时给予肾上腺素，死亡事件仍然发生。食物过敏者必须应对一个需要每天对过敏原保持警惕并为过敏反应做好准备的世界。虽然致命反应的实际风险很小，但并非为零，而且严重反应是不可预测的。临床医生需要帮助患者更好地了解致命反应的极低但真实的风险，并通过适当的教育、安全网和降低风险使他们尽可能过上正常的生活。
Although there is a general perception that the prevalence of food allergy is increasing, data supporting this are limited. Food is the least common cause of fatal anaphylaxis, and fortunately, it is a very rare event; however, it is also unpredictable. There is widespread consensus that severe reactions cannot be predicted in a clinically meaningful way. Certain food triggers are more frequently associated with fatal anaphylaxis than others. In observational studies, peanut and tree nuts account for at least 30% to 50% of fatalities, with seafood and cow’s milk also associated with fatal reactions. Fatal food-induced anaphylaxis is most likely to occur during adolescence and young adulthood, although the reasons for this are unclear. International guidelines agree that intramuscular (IM) epinephrine is the treatment of choice for managing food-triggered anaphylaxis and has a good safety profile when given by the IM route. However, fatalities still occur despite the timely administration of epinephrine. Food-allergic individuals must navigate a world that requires daily vigilance for allergens and preparedness for allergic reactions. Although the actual risk of fatal reactions is minimal, it is not zero, and severe reactions are unpredictable. Clinicians need to help patients better understand the very low but real risk of fatal reaction and enable them to lead as normal a life as possible through appropriate education, safety netting, and risk reduction.