抗蛇毒血清过敏反应分析

目的比较抗蛇毒血清皮试阳性组与抗蛇毒皮试阴性组急性过敏反应及血清病发病情况，观察抗蛇毒血清引起急性过敏反应及血清病的临床表现。方法收集杭州市中医院注射抗蛇毒血清临床病例1162例，记录患者皮试情况，急性过敏、血清病发生情况、临床症状，根据皮试情况分为抗蛇毒血清皮试阳性组与皮试阴性组，抗蛇毒血清皮试阳性组与皮试阴性发生急性过敏反应及血清病的比较采用四格表x2检验。结果抗蛇毒血清皮试阳性72例，通过脱敏注射抗蛇毒血清31例发生急性过敏反应，3例发生血清病；1090例皮试阴性患者中，8例发生急性过敏反应，32例发生血清病；抗蛇毒血清皮试阳性组与抗蛇毒血清皮肤阴性组急性过敏反应发生率差异有统计学意义（P〈0．05）、血清病发生率差异无统计学意义（P〉0．05），急性过敏反应最常见临床症状是：皮肤瘙痒，皮肤红斑、风团；血清病最常见表现是：皮肤红斑、风团，皮肤瘙痒，关节疼痛、发热。结论皮试对预测抗蛇毒血清急性过敏反应发生有参考意义，仍有不确定性，皮试对血清病预防筛选无提示作用。

Analysis of allergic reaction induced by antivenom

Objective To compare incidence of acute anaphylaxis and serum sickness between the antivenom serum skin test positive group and negative group and to observe clinical manifestations of acute anaphylaxis and serum sickness trig- gered by antivenom. Methods The data of 1162 patients receiving antivenom injection in our hospital were collected. The results of skin test, acute allergy, serum sickness incidence, clinical symptoms of patients were recorded, all patients were divided into positive skin test to antivenom group and negative skin test group, X2 fourfold table was used to compare inci- dence of acute anaphylaxis and serum sickness in the two groups. Results In 72 cases of positive skin test to antivenom serum,31 patients developed acute allergic reaction and 3 patients developed serum sickness after desensitization injec- tions;8 patients developed acute allergic reaction and 32 patients developed serum sickness in negative skin test to antivenom;between positive group and negative group, the incidence of acute allergic reactions were significantly different （P 〈 0.05 ） , the incidence of serum sickness was no significant difference （P 〉 0.05 ） , the most common clinical acute al- lergic reactions symptoms included itching, skin erythema, urticaria; while the most common manifestations of serum disea- seincluded skin erythema, urticaria, pruritus ,joint pain, fever. Conchlsion The skin test for predicting acute allergic re- actions antivenin is useful, but still are there uncertainties. Skin test is useless for the preventive screening of serum sick- ness.