食物依赖运动诱发性过敏反应一例并文献复习

目的 提高临床医师对食物依赖运动诱发性过敏反应(FDEIA)的认识.方法 2007年12月至2009年10月通过对1例FDEIA患者的诊断、治疗经过以及随访结果的分析,结合文献复习,详细阐述该病的病冈、临床表现、诊断方法、治疗及预防方法.结果 患者男,18岁,反复出现荨麻疹、呼吸困难及意识障碍8个月,每次发作均是在进食小麦面食后由运动诱发,经抗组胺、肾卜腺素药物和(或)地塞米松治疗后快速缓解.血清食物特异性lgE检测,发现虾、蟹特异性lgE阳性,但临床上无相关过敏症状.小麦-运动激发试验结果阳性,诊断为FDEIA.此后患者禁食小麦面食1年多,期间未发生过敏反应.恢复进食小麦面食后,运动再次诱发FDEIA.结论 FDEIA发病率低,小麦是常见的致敏食物.进食过敏食物后4h内避免剧烈运动有可能避免本病的发生,禁食致敏食物是预防FDEIA的可靠方法.     

小麦依赖-运动诱发的严重过敏反应:15例病例分析

目的对小麦依赖-运动诱发的严重过敏反应(wheat-dependant exercise-induced anaphylaxis,WDEIA)的临床特点进行分析和总结。方法对2004年3月至2007年12月在北京协和医院诊断为WDEIA15例患者的临床表现和发病特点进行总结,检测小麦、面筋、玉米、燕麦、大麦、荞麦、鸡蛋、牛奶等食物的特异性IgE水平,在部分病例进行小麦水溶蛋白、醇溶蛋白皮肤点刺试验;同时进行常见吸入变应原皮内试验和血清特异性IgE检查。结果运动后发生严重过敏反应患者15例,所有患者发病前0.5～6h均进食小麦类食物,确诊前平均发生低血压休克3.2次。15例患者中13例(86.7%)血清小麦IgE(f4)阳性,15例(100%)面筋IgE(f79)阳性。对其中5例患者进行小麦皮肤点刺试验,结果均为阳性。确诊前患者对WDEIA认知度较低,确诊后所有患者遵医嘱严格避免运动前进食小麦类食物,均未再发生严重过敏反应。结论WDEIA是一种诊断困难,在临床上被低估的严重过敏性疾病,但结合病史特点、血清IgE检测和皮肤点刺试验,仍可以被临床医生所认识。     

红肉诱发严重过敏反应的临床病例研究

目的自2009年起,澳大利亚、美国和欧洲相继报道了一种新型食物过敏病例,患者在进食红肉3~6 h后发生严重过敏反应,这种疾病被认为和蜱叮咬及非灵长类哺乳动物阿尔法半乳糖Ig E抗体相关。病例散发于各大洲,本文为我国首次报道。方法对2例进食红肉后迟发严重过敏反应患者的临床表现进行总结并进行蜱叮咬问卷调查。病例1血清和健康对照血清分别与哺乳动物肉和内脏进行免疫印迹实验,观察其特异性结合特点。结果病例1为57岁女性,病例2为44岁男性,均为北京郊县农民。2例患者均在进食红肉后3~6 h多次发生严重过敏反应。患者血清多种哺乳动物蛋白皮肤试验和Ig E抗体均为阳性,且阿尔法半乳糖特异性Ig E均为阳性(分别为6级100 k UL和3级6.00 k UL)。病例1在发病前有蜱叮咬史,捕获其家犬身上蜱,经鉴定为长角血蜱。病例2在发作前无明确蜱叮咬病史。血清免疫印迹实验结果提示病例1血清Ig E与动物肌肉组织和内脏组织均有特异性结合,其中动物内脏阿尔法半乳糖表型表达高于肌肉组织。结论红肉过敏可导致严重临床症状,威胁患者生命。这一疾病可由蜱叮咬引起,值得公众及临床医生关注。确诊为红肉过敏的患者应避免进食相关肉类和内脏等组织。     

氨苯砜过敏反应综合征一例并文献复习

目的探讨氨苯砜(DDS)过敏反应综合征的临床特征和治疗方法。方法报告1例氨苯砜过敏反应综合征并复习相关文献。结果本例患者服用2周DDS后出现发热、皮疹、肝脾肿大、淋巴结肿大、肝损害、异型淋巴细胞增多和低丙种球蛋白血症,确诊为氨苯砜过敏反应综合征,经糖皮质激素治疗效果显著。结论氨苯砜过敏反应综合征的临床特征为发热、皮疹、淋巴结肿大、肝损害和溶血性贫血等。根据DDS的用药史,排除微生物感染和其它相关疾病,可诊断本病。治疗上应尽快使用足量的糖皮质激素并逐步减量维持治疗1个月以上。     

口服阿莫西林致严重过敏反应1例并文献复习

严重过敏反应近年来引起国内外医生广泛关注,国外对此研究较为深入。Liew等[1]的研究提示近年来严重过敏反应发生率增高,而药物引发的严重过敏反应病死率增高,需引起我们重视。青霉素类药物过敏在药物过敏中最为常见,尤其静脉应用时过敏可能引发过敏性休克等严重情况,但口服青霉素类药物引发严重过敏反应并不多见,现报告我院一例口服阿莫西林引发严重过敏反应病例,并结合文献加以分析。     

过敏性肺炎1例并文献复习

<正>病例资料47岁,女性,农民,既往无吸烟史及其它病史。此次主因活动后喘息1年余、加重3月入院。患者2012年3月无明显诱因出现重体力活动后喘息,到当地县医院行心电图及Holter检查未见明显异常,间断服用稳心颗粒治疗,未到呼吸科就诊,未行胸部影像学检查。2013年9月出现喘息加重,日常活动即感喘息明显。2013-10-07到当地医院心内科行冠     

肺鳞癌皮肤转移3例并文献复习

肺癌皮肤转移临床少见,一旦出现多伴有其他部位转移,预后较差,诊断依靠病理学检查。本院自2008年1月至2010年12月发现肺鳞癌皮肤转移3例,报道如下。     

运动诱发严重过敏反应3例

目的分析运动诱发严重过敏反应(exercise-induced anaphylaxis,EIA)特点,以提高对该病认识。方法回顾性分析2014年1月至2015年8月北京协和医院变态反应科诊治的3例EIA患者的临床资料。结果 3例患者分别为男性1例和女性2例,年龄为25~35岁,均表现为反复荨麻疹。其中2例患者曾出现晕厥,每次发作前均处于运动状态,与进食无关,空腹情况下运动也会发生。过敏原皮试及血清特异性Ig E检测均阴性,除外能引起上述症状的其他疾病后,诊断为EIA。通过调整运动习惯和对早期症状的识别,发作次数明显减少,未再出现严重过敏反应。结论 EIA是一少见但威胁生命的疾病,主要依靠详细的病史排除性诊断。通过调整运动习惯可显著减少过敏的发生;对于曾经有致命发作的患者,应随身携带肾上腺素。     

低分子右旋糖酐致严重过敏1例

1 病例简介 患者,女性,70岁,主因发作性胸闷10余年,加重伴心悸10余天,以"冠心病、高血压2级"入院.2002年12月10日护士遵医嘱为病人输入低分子右旋糖酐500 mL,2～3 min后,患者自觉有肢体和舌头麻木,继之出现轻度躁动,神志不清、口唇苍白、呼吸困难,立即停止输入低分子右旋糖酐,改用生理盐水快速滴入,测血压高压50 mmHg,低压测不到,听诊心率98次/min,考虑为过敏反应.迅速给予静脉推注地塞米松5 mg,肾上腺素1 mg,症状稍有好转,测血压50/30 mmHg,但仍有口唇紫绀,四肢湿冷.建立第二通道快速输入生理盐水加用多巴胺,并再次推入地塞米松和肾上腺素.约30 min后症状缓解,在此后的治疗中,避免使用低分子右旋糖酐,患者未再出现类似症状和反应.该患者无其它药物过敏史.     

Food allergy in gastroenterologic diseases： Review of literature

INTRODUCTION Food allergy is recognized as a common worldwide prob- lem, and, like other atopic disorders, its incidence seems to increase. Moreover, food-related allergic disorders are the leading cause of anaphylactic reactions treated in the emer- genc…     

Anaphylaxis caused by lipid transfer proteins: an unpredictable clinical syndrome

Introduction

Lipid transfer proteins (LTPs) are panallergens found in many plant foods. They are a common cause of food-induced anaphylaxis (FIA) in adults living in the Mediterranean area. LTPs have also been proposed as a main cause of food-dependent exercise-induced anaphylaxis (FDEIA).

Food intolerance and skin prick test in treated and untreated irritable bowel syndrome

AIM: To correlate the clinical features of treated and untreated patients with irritable bowel syndrome (IBS) to the results of skin prick test (SPT) for food and inhalant allergens. METHODS: We recruited 105 subjects to form three different target groups: treated group (n=44) undergoing treatment for IBS, untreated group (n=31) meeting the RomeⅡcriteria without treatment for IBS, control group (n=30) with no IBS symptoms. RESULTS: SPT results were different among the three groups in which SPT was positive in 17 (38.6%) treated patients, in 5 (16.1%) untreated patients and in 1 (3.3%) control (P<0.01). The number of positive SPTs was greater in the IBS group than in the control group (P< 0.001). The number of positive food SPTs was higher in the treated IBS group than in the untreated IBS group (P=0.03). CONCLUSION: Positive food SPT is higher in IBS patients than in controls.     

Practical interest of both skin prick test and specific IgE in the evaluation of tolerance acquisition in IgE mediated cow's milk allergy (CMA). A clinical retrospective study in a cohort of 184 children

BackgroundCow's milk protein allergy (CMPA) represents one of the leading causes of food allergy in infants and young children. The immune reaction may be IgE mediated, non-IgE mediated, or mixed. IgE-mediated cow's milk protein allergy is revealed by immediate and acute symptoms which can be severe. The aim of this study is to report a one centre experience in the real life of testing children with IgE-mediated CMPA and try to identify predictive factor for follow-up challenges.MethodRetrospective and monocentric study between September 1997 and February 2008. 178 infants diagnosed with IgE-mediated CMPA during breastfeeding weaning were included. Initial factors such as age, sex, skin prick tests (SPTs), specific IgE (sIgE), atopic dermatitis and types of reaction were noted. Between 12 and 24 months all infants have undergone at least one evaluation including SPT.ResultsAt the food challenge, 138 (75.8%) infants were found tolerant. Results of the skin prick test (SPT) were statistically different according to the food challenge result (2.2 mm vs. 5.1 mm, p < 0.0001). It was the same result for sIgE for CM 2.0 ku/l vs. 11.5 ku/l – p < 0.0001 and for casein 1.0 ku/l vs. 16.0 ku/l – p = 0.0014.ConclusionThis study confirms the practical interest of both SPT and sIgE in the evaluation of tolerance induction in IgE-mediated CMPA, but with no corresponding results. Sensitivity, specificity and probability curves of success for cow's milk challenge can be determined and have clinical utility.     

Colonoscopy-induced Splenic Injury: Report of 3 Cases and Literature Review

Background Since its first report in 1974, 66 cases of splenic injury after colonoscopy have been reported in the world literature. Splenic injury is among the rarest complications of colonoscopy. However, it can be associated with severe morbidity and has rarely been fatal. Objectives Three cases of splenic injury following colonoscopy are described, and the world literature is reviewed. Methods Case reports and literature review. Results Seventy-six percent of the patients were females. When reported, colonoscope insertion was technically difficult in 36% of cases. The onset of symptoms is usually within 48 h of colonoscopy. Abdominal pain was the most common presenting symptom (93% of cases). CT scan and ultrasound each had 100% diagnostic sensitivity when performed. Twenty of 65 cases (31%) with available data were successfully managed supportively with bed rest, transfusion and pain control. Hemodynamic instability was associated with surgical treatment, but no clinical features were perfect predictors of successful conservative therapy or the need for surgery. Conclusions Splenic injury during and after colonoscopy is more common in women. Technically difficult colonoscopy is a possible risk factor. Onset of symptoms is often delayed by hours. CT scan is probably the best diagnostic test for splenic injury after colonoscopy, though the literature indicated ultrasound is also sensitive. Patients with hemodynamic instability are most often operated. Patients with confined intrasplenic hematoma and hemodynamic stability can be given a trial of conservative management.     

Pacemaker Component Allergy: Case Report and Review of the Literature

Pacemaker component allergy is a relatively uncommon cause of erythema and pain at the site of an implanted pacemaker. Allergies to multiple pacemaker components have been well described. We present a case in which 2 component allergies were documented on separate occasions. Although attempts were made to protect the patient by coating the pacemaker, the protective coating was incomplete and the patient again had a clinical reaction. More complete coating corrected the problem. Diagnosis of a pacemaker component allergy first requires awareness of the problem and then thorough allergy testing with appropriate components.     

变态反应性疾病变应原的体内外诊断及分析

目的 应用变应原皮肤点刺试验(SPT)分析西安地区不同变态反应性疾病的主要变应原,同时应用UniCAP 100检泓血清特异性免疫球蛋白E(IgE),并对结果进一步评价.方法 我院变态反应门诊就诊的变态反应性疾病患者679例,选用19种常见的变应原进行SPT,比较不同疾病患者主要变应原阳性率的异同;其中116例患者同时抽取静脉血检测血清粉尘螨特异性IgE,并与SPT结果比较.结果 ①在所有变态反应性疾病患者中,粉尘螨、屋尘螨均是最主要的变应原,总的阳性率分别是49.78%和43.00%,其次依次为蒿属花粉、霉菌、悬铃木属花粉和树Ⅰ花粉等,总阳性率均在10%以上,上述变应原是西安地区变态反应性疾病的主要变应原;②羽毛、鸡蛋、牛奶、蒿属、虾和花生6种变应原的阳性率在4种变态反应性疾病组间比较差异有统计学意义(P<0.05),其余变应原的阳性率在各组间差异无统计学意义,哮喘及过敏性鼻炎组患者的主要变应原以吸入性变应原为主,而荨麻疹组及过敏性紫癜组患者的主要变应原除以上吸入变应原外,还包括鸡蛋、牛奶、虾和花生等食人性变应原;③以血清特异性IgE为标准,以+++及以上为SPT阳性标准时的诊断价值高于以++及以上为SPT阳性标准,且IgE定量与SPT风团直径呈对数关系(r=0.629,P<0.05).结论 粉尘螨、屋尘螨、蒿属花粉、霉菌、悬铃木属花粉和树Ⅰ花粉等变应原是西安地区变态反应性疾病的主要变应原;不同疾病的主要变应原稍有不同;IgE定量与SPT风团直径呈对数关系,两者检测结果可以互补.     

组织胞浆菌病四例报告并文献复习

目的探讨组织胞浆菌病的临床特点、诊断、鉴别诊断及治疗。方法报道我院2008年12月—2009年7月由病理诊断确诊的4例组织胞浆菌病患者,并结合文献探讨该病的临床特征及诊治方法。结果对该病认识不足,通过组织病理活检诊断该病。结论组织胞浆菌病临床表现多样,骨髓象检查或组织病理学检查有确诊价值,使用两性霉素B等抗真菌药物治疗有效。