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Substantial psychosocial impairments in patients with chronic urticaria are associated with delayed referral to urticaria centers, non-academic treatments, and dietary changes.
Pub Date : 2025-02-10 eCollection Date: 2025-01-01 DOI: 10.5414/ALX02554E
Julia Zarnowski, Paula Kage, Regina Treudler

Background: Chronic idiopathic urticaria (CIU) is common in allergological practice. Although therapeutic options have improved in the past decade, patients still suffer from a significant burden of disease and are often treated insufficiently.

Objective: We aimed at analyzing the psychiatric comorbidities, social impairments, and treatment gap in a real-world setting.

Materials and methods: Adult patients with CIU were investigated for demographical data, medical history, and psychosocial burden. Validated questionnaires were used to assess urticaria activity, control of disease, quality-of-life impairment, and psychiatric comorbidities.

Results: 82 patients (78% female; 47.5 ± 14.8 years) were included. 65.9% had insufficient disease control, 11% reported on prior self-medication with drugs, 19.5% were seeking help from non-academic medicine, and 54.9% tried a change of diet. The use of non-academic treatment was significantly associated with higher disease activity. Self-initiated dietary changes were significantly associated with less control of disease. Delayed referrals to a urticaria-specialized center were significantly linked to self-reported psychiatric diseases, self-medication with drugs and self-initiated dietary changes.

Conclusion: Our data show an unsatisfactory control of CIU in many patients and substantial psychosocial impairments which are also associated with a delayed referral to urticaria centers, self-initiated non-academic treatments, and dietary changes.

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引用次数: 0
Significant handling errors and education gaps regarding the use of the emergency kit among adult patients with Hymenoptera venom allergy.
Pub Date : 2025-01-22 eCollection Date: 2025-01-01 DOI: 10.5414/ALX02476E
Julia Zarnowski, Louise Wilkens, Regina Treudler

Aim: In case of systemic anaphylactic reactions after Hymenoptera stings, patients should be provided with an adrenaline autoinjector (AAI). We aimed to evaluate the education and handling competence of patients in a real-world setting.

Materials and methods: Patients with Hymenoptera venom allergy presenting for the first time in our clinic with a previously prescribed emergency kit including an AAI were interviewed using a standardized questionnaire and were asked to demonstrate the AAI use with a dummy.

Results: 82 patients (62.2% female, mean age 52.0 ± 17.3 years) with allergy to wasp venom (85.3%), bee venom (9.8%), or hornet venom (4.9%) were included. 37.8% reported to have received a practical training on the AAI upon prescription. 59.8% of all patients showed significant handling errors which would have led to misinjections in 30.6%.

Conclusion: Our data demonstrate a considerable lack of education, significant handling errors of the emergency kit, and a high risk of misinjections of the AAI. As the emergency kit is potentially lifesaving, the awareness for a sufficient education and training needs to be risen.

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引用次数: 0
Sensitization to food allergens is associated with more severe wheezing in children. 对食物过敏原的敏感与儿童更严重的喘息有关。
Pub Date : 2024-12-31 eCollection Date: 2024-01-01 DOI: 10.5414/ALX02546E
Ozge Yılmaz, Cecilia M Patino, Fatma Taneli, Esra Toprak Kanik, Ahmet Turkeli, Ceyhun Gozukara, Sezen Irmak, Hasan Yuksel

Aims: We investigated sensitization to food allergens as a prognostic factor for wheezing in children with recurrent wheezing and compared serum club cell 16 (CC16) and surfactant protein D (SP-D) among these children with and without sensitization to food allergens.

Materials and methods: Children with recurrent wheezing were enrolled in this prospective cohort study. Specific IgE to five common food allergens (Fx5) was assessed at baseline, and children were followed-up for 1 year for new-onset wheezing episodes. Baseline wheezing severity score, CC16, and SP-D levels were measured.

Results: We enrolled 295 children (44 Fx5(+)). Poisson regression analysis revealed that Fx5 positivity changed the yearly frequency of wheeze by a factor of 1.66 (p = 0.05, 95% CI: (0.99 - 2.75)). Levels of CC16 and SP-D were not significantly different between the groups (p = 0.679 and p = 0.988).

Conclusion: Sensitization to food allergens irrespective of food associated clinical allergy findings is associated with worse prognosis of wheezing in children.

目的:我们研究了食物过敏原致敏作为复发性喘息儿童的预后因素,并比较了这些有和没有食物过敏原致敏的儿童的血清俱乐部细胞16 (CC16)和表面活性蛋白D (SP-D)。材料和方法:复发性喘息儿童被纳入这项前瞻性队列研究。在基线时评估对五种常见食物过敏原(Fx5)的特异性IgE,并对新发喘息发作的儿童进行1年随访。测量基线喘息严重程度评分、CC16和SP-D水平。结果:我们招募了295名儿童(44名Fx5(+))。泊松回归分析显示,Fx5阳性改变喘息年频率的因子为1.66 (p = 0.05, 95% CI:(0.99 - 2.75))。各组间CC16和SP-D水平差异无统计学意义(p = 0.679和p = 0.988)。结论:对食物过敏原的致敏与儿童喘息预后较差有关,而与食物相关的临床过敏结果无关。
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引用次数: 0
Registries in allergy: Structure, target groups, and key findings of allergy-focused registries in Germany. 过敏登记:结构、目标群体和德国过敏登记的主要发现。
Pub Date : 2024-12-31 eCollection Date: 2024-01-01 DOI: 10.5414/ALX02536E
Marie Farkic, Philipp Globig, Aikaterina Alexiou, Margitta Worm

In allergology, clinical registries fill knowledge gaps of epidemiology, mechanisms of allergic diseases, and real-world treatment outcomes. Considering the continuous rise of allergic diseases worldwide, registries become increasingly important for the optimization and harmonization of patient care. In the current review, we present four ongoing allergy-focused registries initiated in Germany. We conducted a focused literature search and discussed their structure, main purposes, and findings. Registries included are the "Information Network of Departments of Dermatology", the "European Anaphylaxis Registry", the "GAN Severe Asthma Registry", and "TREATgermany". Despite differences in scope and operation, all registries gather harmonized real-world data that is indispensable for evidence-based decision making in clinical practice and ultimately improves patient care in allergology.

在过敏症学中,临床登记填补了流行病学、过敏性疾病机制和现实世界治疗结果方面的知识空白。考虑到世界范围内过敏性疾病的持续上升,登记对患者护理的优化和协调变得越来越重要。在当前的综述中,我们介绍了在德国启动的四个正在进行的以过敏为重点的注册。我们进行了重点文献检索,并讨论了它们的结构、主要目的和发现。登记包括“皮肤科信息网络”、“欧洲过敏反应登记”、“GAN严重哮喘登记”和“德国治疗”。尽管范围和操作存在差异,但所有注册都收集了统一的真实世界数据,这些数据对于临床实践中的循证决策是不可或缺的,并最终改善了过敏症患者的护理。
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引用次数: 0
Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI). 职业性过敏反应:德国过敏学和临床免疫学学会(DGAKI)的立场文件。
Pub Date : 2024-11-28 eCollection Date: 2024-01-01 DOI: 10.5414/ALX02543E
Regina Treudler, Margitta Worm, Andrea Bauer, Heinrich Dickel, Guido Heine, Uta Jappe, Ludger Klimek, Monika Raulf, Bettina Wedi, Dorothea Wieczorek, Wojciech Francuzik, Thilo Jakob, Oliver Pfaar, Johannes Ring, Franziska Rueff, Sabine Schnadt, Thomas Werfel, Gerda Wurpts, Julia Zarnowski, Torsten Zuberbier, Knut Brockow

Background: Anaphylaxis is a systemic allergic reaction that is potentially life-threatening. Occupational anaphylaxis is an anaphylaxis that occurs in an occupational context. In this position paper, we propose diagnostic criteria for occupational anaphylaxis and provide an overview of the current state of knowledge in terms of prevalence, triggers, prevention, and management.

Results: The most common triggers of occupational anaphylaxis include Hymenoptera venoms, followed by food and drugs. Chemicals, bites or contact with animals (mammals/snakes/insects) and natural rubber latex are far less common. Occupations at risk for occupational anaphylaxis are therefore beekeepers, outdoor workers, or those who handle food as well as healthcare workers. The route of contact, intensity, and frequency of exposure, type of allergen, and the simultaneous occurrence of co-factors determine the clinical manifestation. A detailed medical history is required to confirm the diagnosis of anaphylaxis and to identify the trigger. Both skin tests and the determination of specific IgE are recommended, but only very few commercially available and quality-tested allergens are available that can be examined using both test methods. Preventive measures are based on avoiding further exposure or, if necessary, replacing a working substance. A written emergency plan and the prescription of an adrenaline autoinjector as well as instructions for its use are mandatory. Allergen immunotherapy is recommended for systemic Hymenoptera venom allergy. Depending on the national healthcare systems, patients with occupational anaphylaxis must be reported to the accident insurance.

Conclusion: Occupational anaphylaxis is very rare. We recommend educational measures and generally standardized recording of occupational anaphylaxis for occupations with an increased risk of anaphylaxis.

背景:过敏反应是一种可能危及生命的全身性过敏反应。职业性过敏反应是一种发生在职业环境中的过敏反应。在这篇立场论文中,我们提出了职业性过敏反应的诊断标准,并概述了目前在患病率、诱因、预防和管理方面的知识状况。结果:职业性过敏反应的最常见诱因为膜翅目昆虫毒液,其次为食物和药物。化学品,咬伤或与动物(哺乳动物/蛇/昆虫)和天然橡胶乳胶接触的情况要少得多。因此,职业性过敏反应风险的职业是养蜂人、户外工作者或处理食品的人员以及卫生保健工作者。接触途径、接触强度、接触频率、过敏原类型以及同时发生的辅助因素决定了临床表现。需要详细的病史来确认过敏反应的诊断和确定触发因素。皮肤试验和特定IgE的测定都是推荐的,但是只有很少的市售的和经过质量测试的过敏原可以同时使用这两种测试方法进行检测。预防措施是基于避免进一步接触或在必要时更换工作物质。书面应急计划和肾上腺素自动注射器的处方以及使用说明是强制性的。过敏原免疫疗法推荐用于全身性膜翅虫毒液过敏。根据国家卫生保健系统,职业性过敏反应患者必须报告给意外保险。结论:职业性过敏反应非常罕见。我们建议对过敏反应风险增加的职业采取教育措施和一般标准化的职业过敏反应记录。
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引用次数: 0
Biologics in allergology and clinical immunology: Update on therapies for atopic diseases, urticaria, and angioedema and on safety aspects focusing on hypersensitivity reactions. 过敏症和临床免疫学中的生物制剂:特应性疾病、荨麻疹和血管性水肿疗法的最新进展,以及以超敏反应为重点的安全性问题。
Pub Date : 2024-11-14 eCollection Date: 2024-01-01 DOI: 10.5414/ALX02533E
Uta Jappe, Karl-Christian Bergmann, Folke Brinkmann, Valentina Faihs, Askin Gülsen, Ludger Klimek, Harald Renz, Sebastian Seurig, Christian Taube, Stephan Traidl, Regina Treudler, Martin Wagenmann, Thomas Werfel, Margitta Worm, Thorsten Zuberbier

The development of targeted therapies for atopic diseases, urticaria, and angioedema with biologics is progressing rapidly: New "targets" of clinical-therapeutic relevance have been identified, the corresponding targeted antibodies developed, tested in clinical trials, and approved for therapy. These include the anti-IgE antibody omalizumab (also effective and approved for the treatment of urticaria), the anti-IL-4/13 receptor-specific antibody dupilumab, the two anti-IL-13 antibodies lebrikizumab and tralokinumab, the anti-TSLP antibody tezepelumab, the two anti-IL-5 antibodies mepolizumab and reslizumab, and the anti-IL5 receptor-specific antibody benralizumab for the treatment of atopic diseases. For the treatment of hereditary angioedema, C1 inhibitor and the antibody lanadelumab (directed against kallikrein) have also long been approved as biologics in addition to low-molecular substances. Other therapeutic antibodies are in various stages of development. Furthermore, the range of indications for some very effective biologics has been successfully expanded to include additional diseases. In this context, the first results on biologic therapy of food allergy and eosinophilic esophagitis are interesting. Biologics that address different target structures are also increasingly being administered in combination, either simultaneously or sequentially, in order to achieve optimal efficacy. A developing area is the use of biologics in children and the observation of immunological and non-immunological side effects. In some cases, new unexpected side effects and hypersensitivity reactions have emerged, which in turn raise pathomechanistic questions, such as conjunctivitis with dupilumab therapy, which only appears to occur in the treatment of atopic dermatitis but not in the treatment of other atopic diseases. In dermatology, paradoxical reactions have been described under therapy with some biologics. And immune reactions of type alpha to epsilon to biologics (hypersensitivity reactions) continue to be a clinically relevant problem, whereby the selection of an alternative therapeutic agent is a challenge and the diagnostics that support this have not yet been sufficiently incorporated into routine work.

针对特应性疾病、荨麻疹和血管性水肿的生物制剂靶向疗法的开发进展迅速:与临床治疗相关的新 "靶点 "已被确定,相应的靶向抗体也已开发出来,并在临床试验中进行了测试和批准用于治疗。其中包括抗 IgE 抗体奥马珠单抗(治疗荨麻疹也有效并已获批)、抗 IL-4/13 受体特异性抗体杜必鲁单抗(dupilumab)、两种抗 IL-13 抗体 lebrikizumab 和 tralokinumab、抗 TSLP 抗体 tezepelumab、两种抗 IL-5 抗体 mepolizumab 和 reslizumab,以及用于治疗特应性疾病的抗 IL5 受体特异性抗体 benralizumab。在治疗遗传性血管性水肿方面,除低分子物质外,C1 抑制剂和抗体 lanadelumab(针对 kallikrein)也早已被批准为生物制剂。其他治疗性抗体正处于不同的开发阶段。此外,一些非常有效的生物制剂的适应症范围已成功扩大到其他疾病。在这方面,生物制剂治疗食物过敏和嗜酸性粒细胞食管炎的首批研究成果令人关注。针对不同目标结构的生物制剂也越来越多地同时或依次联合使用,以达到最佳疗效。在儿童中使用生物制剂以及观察免疫和非免疫副作用是一个不断发展的领域。在某些情况下,出现了新的意想不到的副作用和超敏反应,这反过来又提出了病理机制方面的问题,例如使用杜比鲁单抗治疗结膜炎,这种情况似乎只发生在特应性皮炎的治疗中,而不发生在其他特应性疾病的治疗中。在皮肤病学领域,一些生物制剂在治疗过程中也出现了矛盾反应。对生物制剂的α至ε型免疫反应(超敏反应)仍然是一个临床相关问题,因此选择替代治疗药物是一项挑战,而支持这一挑战的诊断方法尚未充分纳入常规工作中。
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引用次数: 0
Dietary and physical trigger factors in hereditary angioedema: Self-conducted investigation and literature overview. 遗传性血管性水肿的饮食和物理诱发因素:自我调查和文献综述。
Pub Date : 2024-11-14 eCollection Date: 2024-01-01 DOI: 10.5414/ALX02523E
Julia Zarnowski, Regina Treudler

Background: In hereditary angioedema (HAE), numerous factors are known to trigger an attack. The possible influence of diet or recreational sports has been given little consideration in studies. The aim of our work was to investigate the influence of nutrition and physical activity in patients with HAE at the Leipzig ACARE Center.

Materials and methods: Patients with HAE were given a self-designed questionnaire inquiring for family history, disease progression, and encountered burden due to HAE, current therapy, and disease control (angioedema control test (AECT)) as well as the influence of diet and/or recreational sports on HAE attacks.

Results: Inclusion of 30 patients (23 female, 77%) with a mean age of 49.5 ± 16.9 years and mean body mass index of 25.1 ± 6.4 kg/m2. 60% received prophylactic treatment, and 37% received exclusively on-demand therapy. The mean AECT score was 10.9 ± 5.1 and patients reported 15.5 ± 26.9 days of absence due to HAE attacks in the last 12 months. 33% reported an association with food intake, in particular worsening of abdominal symptoms (n = 7), swelling of the extremities (n = 3), face, larynx, or genital area (n = 1 each). 70% reported regular exercise, most commonly cycling (n = 11), running or walking (n = 10), or strength training (n = 10). 62% reported a worsening of HAE due to recreational exercise.

Conclusion: Dietary factors and physical activity frequently led to an aggravation of HAE in our cohort and should be taken into consideration when counseling patients with regard to trigger avoidance.

背景:遗传性血管性水肿(HAE)的发病诱因众所周知。研究很少考虑饮食或休闲运动可能产生的影响。我们的工作旨在调查莱比锡 ACARE 中心的 HAE 患者中营养和体育锻炼的影响:我们向HAE患者发放了一份自行设计的调查问卷,调查内容包括家族病史、疾病进展情况、因HAE造成的负担、当前治疗情况、疾病控制情况(血管性水肿控制测试(AECT))以及饮食和/或休闲运动对HAE发作的影响:共纳入 30 名患者(23 名女性,77%),平均年龄为 49.5 ± 16.9 岁,平均体重指数为 25.1 ± 6.4 kg/m2。60%的患者接受了预防性治疗,37%的患者只接受了按需治疗。平均AECT评分为10.9±5.1分,患者报告在过去12个月中因HAE发作缺勤15.5±26.9天。33%的患者表示与进食有关,尤其是腹部症状加重(7 例)、四肢肿胀(3 例)、面部、喉部或生殖器部位肿胀(各 1 例)。70%的患者表示经常锻炼,最常见的是骑自行车(11 例)、跑步或散步(10 例)或力量训练(10 例)。62%的患者表示,娱乐性运动导致HAE恶化:结论:在我们的队列中,饮食因素和体育锻炼经常导致 HAE 恶化,因此在指导患者避免诱发因素时应加以考虑。
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引用次数: 0
The international HAE guideline under real-life conditions: From possibilities to limits in daily life - current real-world data of 8 German angioedema centers. 现实条件下的国际 HAE 指南:从日常生活中的可能性到局限性--德国 8 家血管性水肿中心当前的实际数据。
Pub Date : 2024-11-14 eCollection Date: 2024-01-01 DOI: 10.5414/ALX02530E
Jens Greve, Robin Lochbaum, Susanne Trainotti, Eva-Vanessa Ebert, Thomas Buttgereit, Antonia Scherer, Lisa Knipps, Anna Smola, Sebastian Volc, Andreas Recke, Katharina Marlies Duda, Mathias Sulk, Janina Hahn

Background and objectives: Patients with rare diseases like hereditary angioedema (HAE) are usually referred to an angioedema center to ensure guideline-compliant and experience-based therapy. Even though there are established guidelines and several approved therapeutics, there are still open questions and situations in the daily care of HAE patients, where an exchange between centers is needed.

Materials and methods: A survey was conducted among physicians from German angioedema centers regarding challenges and issues in everyday HAE treatment. The main focus was on the topic of long-term prophylaxis (LTP). For rarer subcategories of angioedema, the centers conducted a literature review to discuss open questions.

Results: The responses of 12 physicians from 8 angioedema centers were analyzed in the survey. The attack frequency was the most important criterion for deciding to initiate LTP in HAE patients (100%). Two centers no longer generally recommend the initiation of pre-interventional prophylaxis in HAE patients under LTP. The therapeutic concepts of acquired angioedema due to C1 inhibitor deficiency and HAE in children were two associated specialized areas that were discussed in more detail.

Conclusion: The current guideline serves as the foundation for daily practice in treating HAE at specialized centers. Thus, for rare conditions like HAE, an exchange among the treating centers is essential to adequately address specific issues and rare subgroups.

背景和目的:遗传性血管性水肿(HAE)等罕见疾病患者通常被转诊至血管性水肿中心,以确保治疗符合指南要求并以经验为基础。尽管有既定的指南和几种已获批准的疗法,但在 HAE 患者的日常护理中仍存在一些未决问题和情况,需要各中心之间进行交流:我们对德国血管性水肿中心的医生进行了一项调查,内容涉及 HAE 日常治疗中的挑战和问题。调查的重点是长期预防(LTP)。对于较罕见的血管性水肿亚类,各中心进行了文献综述,以讨论开放性问题:调查分析了来自 8 个血管性水肿中心的 12 名医生的回答。发作频率是决定对 HAE 患者启动 LTP 的最重要标准(100%)。有两个中心一般不再建议对接受 LTP 治疗的 HAE 患者进行介入前预防。C1抑制剂缺乏引起的获得性血管性水肿和儿童HAE的治疗理念是两个相关的专业领域,对此进行了更详细的讨论:目前的指南是专科中心治疗 HAE 日常实践的基础。因此,对于像 HAE 这样的罕见病症,治疗中心之间的交流对于充分解决特定问题和罕见亚群至关重要。
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引用次数: 0
Hereditary angioedema (HAE) in children and adolescents: New treatment options. 儿童和青少年遗传性血管性水肿(HAE):新的治疗方案。
Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI: 10.5414/ALX02532E
Maria Fasshauer, Bettina Wedi

Modern management of hereditary angioedema (HAE) due to reduced C1 inhibitor (C1-INH) function or concentration (HAE-C1-INH) focuses on individualized therapeutic strategies to address the specific needs of children and adolescents as well as the severity of the disease. Psychosocial factors such as the burden of disease and therapy on quality of life and participation play an important role. New medications have already significantly improved the prognosis and health related quality of life in HAE patients, but not all of these therapies have yet been approved for children. Further treatment options that inhibit bradykinin effects are currently being investigated. They target factor XIIa, prekallikrein, plasma kallikrein, or the bradykinin B2 receptor. Modern research focuses on oral options or long-acting parenteral therapy approaches to further optimize care and, in particular, the needs of children. There are also initial developments in the field of gene therapy, which could represent a causal treatment option for HAE in the future. This article focuses on the presentation and treatment of HAE type I (reduced C1-INH concentration) and HAE type II (impaired C1-INH function) in children and adolescents. Acquired AE and HAE with normal C1-INH are rare in the pediatric age group and are not discussed in detail here.

由于 C1 抑制剂(C1-INH)功能或浓度降低而导致的遗传性血管性水肿(HAE)(HAE-C1-INH)的现代治疗方法侧重于个体化治疗策略,以满足儿童和青少年的特殊需求以及疾病的严重程度。疾病和治疗对生活质量和参与度造成的负担等社会心理因素也起着重要作用。新药已经大大改善了 HAE 患者的预后和与健康相关的生活质量,但并非所有这些疗法都已获准用于儿童。目前正在研究抑制缓激肽效应的其他治疗方案。它们以因子 XIIa、prekallikrein、血浆缓激肽或缓激肽 B2 受体为靶点。现代研究的重点是口服选择或长效肠外治疗方法,以进一步优化护理,尤其是满足儿童的需求。基因治疗领域也有了初步发展,这可能是未来治疗 HAE 的一种因果疗法。本文重点介绍儿童和青少年 HAE I 型(C1-INH 浓度降低)和 HAE II 型(C1-INH 功能受损)的表现和治疗方法。获得性 AE 和 C1-INH 正常的 HAE 在儿童年龄组中较为罕见,本文不作详细讨论。
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引用次数: 0
Long-term tolerance and efficacy of venom immunotherapy after an episode of Crohn's disease and ankylosing spondylitis after up-dosing. 克罗恩病和强直性脊柱炎发作后,毒液免疫疗法在增加剂量后的长期耐受性和疗效。
Pub Date : 2024-10-24 eCollection Date: 2024-01-01 DOI: 10.5414/ALX02526E
Marius Winkler, Franziska Ruëff, Silvan Lange, Annett Walker, Eva Oppel

Hymenoptera stings can cause severe anaphylactic reactions in patients with an underlying Hymenoptera venom allergy (HVA). In such cases, venom immunotherapy (VIT) is a highly effective measure to prevent future anaphylaxis. The management of patients with a clear allergological indication for VIT and contraindications to VIT (e.g., autoimmune diseases) remains a clinical challenge. We report the case of a 54-year-old male gardener who experienced life-threatening anaphylaxis after being stung by wasps in the head and neck region. After confirmation of a Vespula venom allergy (VVA) by intradermal test and VV-specific serum IgE antibodies, VIT was started using a rush protocol. One month after reaching the maintenance dose, the patient experienced a worsening of his pre-existing Crohn's disease and ankylosing spondylitis. VIT was stopped, and the autoimmune diseases were treated with systemic steroids and sulfasalazine. As the patient wished to remain in his profession, and in view of the previous severe anaphylaxis, we restarted VIT after the autoimmune diseases had resolved, using a slower up-dosing protocol. This approach was tolerated without side effects, and the patient tolerated a sting challenge and several field stings without anaphylactic symptoms.

对膜翅目昆虫毒液过敏(HVA)的患者被膜翅目昆虫蜇伤后会出现严重的过敏反应。在这种情况下,毒液免疫疗法(VIT)是预防未来过敏性休克的高效措施。如何管理有明确过敏适应症但无毒液免疫疗法禁忌症(如自身免疫性疾病)的患者仍是一项临床挑战。我们报告了一名 54 岁男性园丁的病例,他在头颈部被黄蜂蜇伤后出现了危及生命的过敏性休克。在通过皮内试验和 VV 特异性血清 IgE 抗体确诊为 Vespula 毒液过敏(VVA)后,开始使用 VIT 急诊方案。在达到维持剂量一个月后,患者原有的克罗恩病和强直性脊柱炎病情恶化。于是停用了 VIT,并使用全身类固醇和柳氮磺胺吡啶治疗自身免疫性疾病。由于患者希望继续从事他的职业,并考虑到之前发生的严重过敏性休克,我们在自身免疫性疾病缓解后重新开始使用 VIT,并采用了一种较慢的加量方案。这种方法没有副作用,患者能够耐受蜇伤挑战和数次野外蜇伤,没有出现过敏性症状。
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Allergologie select
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