Time to revisit the definition and clinical criteria for anaphylaxis?
Time to revisit the definition and clinical criteria for anaphylaxis?
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DOI：
10.1016/j.waojou.2019.100066
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发表时间：
2019-10-01
影响因子：
5.1
通讯作者：
Cardona, Victoria
中科院分区：
文献类型：
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作者：
Turner, Paul J.;Worm, Margitta;Cardona, Victoria
过敏反应是过敏反应谱中最严重的一种。目前在文献中发现了许多不同的速发型过敏反应定义（表1）。1-6许多人将过敏性反应定义为危及生命的反应。然而，来自大型病例系列和患者登记研究的数据表明，尽管绝大多数速发过敏反应没有通过及时给予肾上腺素/肾上腺素进行适当治疗，但通常这不会导致死亡率或发病率增加（如住院）7- 9;这一观察结果也与食物过敏反应的国家流行病学数据一致，这些数据表明致命的过敏反应是罕见的（但不可预测的）事件。10-12因此，大多数速发过敏反应本身不能被描述为危及生命，尽管由于我们无法预测反应的严重程度，12我们强调所有速发过敏反应都必须用肌肉注射肾上腺素/肾上腺素进行适当治疗。澳大利亚临床免疫学和变态反应学会（ASCIA）4和国家变态反应和传染病研究所（NIAID）5使用的描述都将过敏反应称为严重过敏反应，并承认在确定过敏反应危及生命的可能性方面的严重程度范围。第二届NIAID/食物过敏和过敏反应网络研讨会提出了诊断过敏反应的临床标准，5该标准随后被世界变态反应组织采纳（表2）。1值得注意的是，这些标准不是定义，而是诊断的辅助工具。当时，人们承认该标准旨在正确识别至少95%的过敏反应（即灵敏度> 95%）;然而，作者认为“需要建立其效用并确定是否需要在前瞻性多中心临床调查中进一步完善”。5
Anaphylaxis represents the severe end of the spectrum of allergic reactions. A number of different definitions for anaphylaxis are currently found in the literature (Table 1). 1– 6 Many define anaphylaxis as a life-threatening reaction. However, data from large case series and patient registries have demonstrated that despite the fact that the vast majority of anaphylaxis reactions are not treated appropriately with prompt administration of epinephrine/adrenaline, in general this does not result in increased mortality or morbidity (such as hospitalization) 7– 9; this observation is also consistent with national epidemiological data for food anaphylaxis, which indicate that fatal anaphylaxis is a rare (but unpredictable) event. 10–12 Therefore, the majority of anaphylaxis reactions cannot be described as life-threatening in themselves, although due to our inability to predict severity of reaction, 12 we emphasize that all anaphylaxis must be appropriately treated with intramuscular epinephrine/adrenaline. Both the descriptions used by the Australasian Society of Clinical Immunology and Allergy (ASCIA) 4 and National Institute of Allergy and Infectious Disease (NIAID) 5 refer to anaphylaxis as a serious allergic reaction, and acknowledge the spectrum of severity in terms of identifying the potential for anaphylaxis to be life-threatening.In 2005, the Second NIAID/Food Allergy and Anaphylaxis Network symposium proposed clinical criteria for diagnosing anaphylaxis, 5 which were subsequently adopted by the World Allergy Organization (Table 2). 1 Of note, these criteria are not a definition, but rather, an aid to diagnosis. At the time, it was acknowledged that the criteria were designed to correctly identify at least 95% of anaphylaxis (ie with a sensitivity of> 95%); however, the authors identified the “need to establish their utility and determine whether there is need for further refinement in prospective multicenter clinical surveys”. 5