Optimal Treatment of Anaphylaxis: Antihistamines Versus Epinephrine
Optimal Treatment of Anaphylaxis: Antihistamines Versus Epinephrine
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DOI：
10.3810/pgm.2014.07.2785
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发表时间：
2014-07-01
影响因子：
4.2
通讯作者：
Fineman, Stanley M.
中科院分区：
文献类型：
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作者：
Fineman, Stanley M.
过敏反应是一种在接触某些外来物质后发生的快速、全身性、通常是意想不到的、可能危及生命的免疫反应。主要的免疫学触发因素包括食物、昆虫毒液和药物。过敏反应有多种免疫学途径，但大多数涉及免疫激活和免疫调节剂的释放。过敏反应在临床上可能很难识别，这使得鉴别诊断成为关键。在过去的几十年里，过敏反应的发生率至少翻了一番，仅在美国，估计每年就有1500人死于过敏反应。过敏反应的发生率和潜在威胁生命的性质，加上诊断方面的挑战，使得适当和及时的治疗至关重要。肾上腺素被普遍推荐作为过敏反应的一线治疗方法，早期治疗对于防止潜在的致命后果至关重要。尽管有证据和指南建议支持使用肾上腺素治疗过敏反应，但肾上腺素仍然没有得到充分利用。数据表明，抗组胺药物更常用于治疗过敏反应患者。虽然组胺与过敏反应有关，但抗组胺药物的治疗并不能缓解或预防过敏反应的所有病理生理症状，包括更严重的并发症，如呼吸道阻塞、低血压和休克。此外，抗组胺药物的作用不像肾上腺素那样迅速；抗组胺药物的最大血药浓度在1至3小时内达到，而肌肉注射肾上腺素的最高血药浓度为10分钟。这表明有必要改进方法，教育医生和患者有关过敏反应的适当治疗。
Anaphylaxis is a rapid, systemic, often unanticipated, and potentially life-threatening immune reaction occurring after exposure to certain foreign substances. The main immunologic triggers include food, insect venom, and medications. Multiple immunologic pathways underlie anaphylaxis, but most involve immune activation and release of immunomodulators. Anaphylaxis can be difficult to recognize clinically, making differential diagnosis key. The incidence of anaphylaxis has at least doubled during the past few decades, and in the United States alone, an estimated 1500 fatalities are attributed to anaphylaxis annually. The increasing incidence and potentially life-threatening nature of anaphylaxis coupled with diagnostic challenges make appropriate and timely treatment critical. Epinephrine is universally recommended as the first-line therapy for anaphylaxis, and early treatment is critical to prevent a potentially fatal outcome. Despite the evidence and guideline recommendations supporting its use for anaphylaxis, epinephrine remains underused. Data indicate that antihistamines are more commonly used to treat patients with anaphylaxis. Although histamine is involved in anaphylaxis, treatment with antihistamines does not relieve or prevent all of the pathophysiological symptoms of anaphylaxis, including the more serious complications such as airway obstruction, hypotension, and shock. Additionally, antihistamines do not act as rapidly as epinephrine; maximal plasma concentrations are reached between 1 and 3 hours for antihistamines compared with, 10 minutes for intramuscular epinephrine injection. This demonstrates the need for improved approaches to educate physicians and patients regarding the appropriate treatment of anaphylaxis.