Ca^＋＋对链霉素抗原—抗体反应的抑制作用

为探讨临床中使用钙制剂抢救链霉素过敏休克病人有良好效果的原因,由被动血凝试验、被动皮肤过敏试验和ELISA法证实,Ca~( )可以抑制链霉素抗原-抗体的反应。这种抑制作用是通过Ca~( )链霉素抗原结合,封闭链霉素抗原决定簇来加以实现的。     

Analysis of sensitization to carboxymethylcellulose: Identification of high risk group using ELISA and histamine release experiment

Objective and Design: Carboxymethylcellulose (CMC) has been considered to be inert and is commonly used as an additive in medicines, foods and cosmetics. However, we experienced a patient who developed an anaphylactic reaction to CMC after an upper gastrointestinal examination using a barium meal containing CMC. Therefore, we examined the incidence of sensitization by CMC in healthy subjects, and categorized the high risk group prone to developing anaphylactic response to CMC.Methods: An ELISA for detecting CMC-specific IgE antibody was developed using serum from the patient as a positive control. In the ten subjects exhibiting high anti-CMC IgE among 387 normal populations, histamine release from isolated leukocytes was performed.Results: Five of ten subjects with a high IgE titer showed a significant CMC-induced histamine release from leukocyte preparations in vitro as observed in the patient, and were classified as high risk group. There was a correlation between sensitization by CMC and that by Japanese cedar pollen. The incidence of sensitization in females was 2.4 fold higher than that in males.Conclusions: The combination of ELISA and histamine release experiment made it possible to identify the high risk group for developing anaphylactic response. The administration of high dose CMC as a suspending agent in barium sulfate or injectable corticosteroids to this group should be avoided to prevent anaphylactic reactions in the clinic.Received 18 August 2003; returned for revision 29 September 2003; accepted by M. J. Parnham 10 December 2003     

The radioimmunoassay of histamine release from circulating basophils in an in vitro study as support for the in vivo active systemic anaphylaxis test in the guinea pig

An in vitro anaphylaxis test is described which explores the ability of compound re-challenge to induce histamine release from polynuclear basophils in whole blood of guinea pigs that had previously been sensitised. This test is used in drug safety, in support of the in vivo active systemic anaphylaxis test, which is sometimes required by regulatory authorities, when the observed clinical signs are not conclusive. This sensitive and discriminative test is inexpensive and reduces animal utilisation.     

《严重过敏反应急救指南》临床问题与结局指标的收集和确定

目的: 确定纳入《严重过敏反应急救指南》的临床问题与结局指标。方法: 由指南指导委员会7位临床医学、药学及护理学专家参考国际指南指导项目组起草、修订拟纳入指南的临床问题与结局指标初稿。临床问题分为背景问题与前景问题,其中背景问题在专家共识组共22位临床专家修订后直接纳入指南范围,前景问题与结局指标将通过三轮德尔菲法对共识组临床专家咨询形成终稿。研究在方法学家全程监督下完成,并通过分析积极系数、变异系数与分值频率等指标进行质量控制。结果: 问题征集初拟共纳入34个前景问题、6个背景问题及6个结局指标,背景问题经专家组修订后直接纳入指南。使用德尔菲法(Delphi method)对前景问题与结局指标的重要程度进行分级后,最终确定28个关键前景问题及6个结局指标纳入指南范围。其中,4个结局指标为关键性结局,其余2个为重要结局,纳入的28个关键前景问题分为严重过敏反应的诊断、救治准备、救治措施及救治后的管理四个部分,另有5个重要问题和1个次要问题此次未纳入指南,供指南修订或更新时参考或讨论。研究中专家响应的积极程度高,积极系数为100%;前景问题的共识程度高,4分及以上的问卷频率均≥0.75;结局指标中,病死率及疾病严重程度的共识程度高,变异系数≤15%。结论: 在全面严谨的信息收集基础上,以德尔菲法的方式确定了需要纳入《严重过敏反应急救指南》的临床问题与结局指标为该指南的后续制定工作奠定了基础。     

Successful mRNA COVID-19 Vaccination and Colonoscopy After Oral Desensitization in a Patient With Polyethylene Glycol Allergy

Anaphylaxis to polyethylene glycol (PEG) is rare and mainly occurs with the use of laxatives containing PEG. Recently, an increasing number of PEG allergies have been reported, particularly those related to coronavirus disease 2019 (COVID-19) vaccines. mRNA COVID-19 vaccines, such as the BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna) vaccines, contain PEG2000 as an excipient and are contraindicated when allergy to a vaccine component exist. We report a 55-year-old woman’s history as a case of successful mRNA COVID-19 vaccination and colonoscopy after oral desensitization to PEG in a patient with PEG allergy who required both COVID-19 vaccination and colon evaluation. Allergy to PEG was diagnosed based on clinical history, skin test results, and basophil histamine release testing. Oral desensitization effectively suppressed histamine release from basophils in response to PEG stimulation, suggesting that oral desensitization using PEG-based laxatives may be an effective treatment option for patients with allergy to the substance.     

Causes and Diagnostic Usefulness of Tryptase Measurements for Anaphylaxis in a Korean Tertiary Care General Hospital

PurposeThe causes of anaphylaxis in a general hospital may differ from those occurring in a community setting. Underlying diseases in admitted patients and vague presenting symptoms can make the diagnosis of anaphylaxis difficult. Serum tryptase measurements may provide valuable evidence for diagnosing anaphylaxis in admitted patients.Materials and MethodsThis study was designed as a retrospective study of 53 patients with an anaphylaxis episode at a Korean tertiary care general hospital. Tryptase levels were measured at baseline and different time points from the onset of anaphylaxis.ResultsDrugs (42 cases; 79.2%) and foods (10 cases; 18.9%) were the most common causes of anaphylaxis. In drug-induced anaphylaxis, antibiotics (24.5%), anticancer medications, which included monoclonal antibodies (22.6%), and contrast agents (11.3%) were the most frequent causes. The muscle relaxant eperisone (5.7%), neuromuscular blocking agent rocuronium (5.7%), and its antagonist sugammadex (3.8%) were other frequent triggering agents. Wheat-dependent exercise-induced anaphylaxis was the most common entity in food-induced anaphylaxis. Tryptase concentrations were higher in patients with higher grades of anaphylaxis, as well as in accidental anaphylaxis, compared to meticulously provoked anaphylaxis. Overall diagnostic sensitivity was higher for tryptase algorithm criteria (≥[1.2×baseline+2] µg/L: 71.4%) than for abnormal tryptase level criteria (≥11.4 µg/L: 52.8%).ConclusionThe triggers of anaphylaxis in a Korean tertiary care hospital were diverse, including beta-lactam antibiotics, anticancer medications, contrast medias, eperisone, nonsteroidal anti-inflammatory drugs, rocuronium, sugammadex, and wheat. Tryptase measurements provided valuable evidence for diagnosis, and the sensitivity of algorithm criteria was superior to that of the abnormal value criteria.