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Rectorragies révélatrices d’une allergie alimentaire après une transplantation hépatique : à propos d’un cas 肝脏移植后显示食物过敏的直肠：关于一个病例

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-08-11 DOI: 10.1016/j.reval.2025.104600

M. Sabib, T. Meskini, S. Ettair

Les allergies alimentaires et hypersensibilités médicamenteuses sont des complications de plus en plus reconnues après transplantation hépatique pédiatrique, avec une prévalence pouvant atteindre 54,3 %. Les allergies alimentaires IgE-médiées se manifestent fréquemment par des signes cutanés et des symptômes gastro-intestinaux tels que douleurs abdominales et diarrhées, tandis que les rectorragies comme présentation initiale restent rares. Nous rapportons le cas original d’une fillette de 12 mois ayant bénéficié d’une transplantation hépatique à l’âge de 9 mois. Elle présentait une atrésie des voies biliaires, initialement traitée par dérivation bilio-digestive sans succès, ayant évolué vers une cirrhose hépatique compliquée d’insuffisance hépatocellulaire, motivant la greffe hépatique et la mise en place d’une immunosuppression par tacrolimus. Elle a présenté deux épisodes de rectorragies de grande abondance. Une évaluation allergologique a confirmé une allergie IgE-médiée à l’œuf et une proctocolite hémorragique associée à une hypersensibilité aux protéines du lait de vache. De plus, une hypersensibilité à l’aspirine a été confirmée par un test de provocation orale. La prise en charge a inclus un régime d’éviction de l’œuf de poule et du lait de vache ainsi qu’un protocole de désensibilisation à l’aspirine, entraînant une amélioration clinique juste après éviction des allergènes. La survenue de ces rectorragies pourrait s’expliquer par des perturbations immunitaires induites par la transplantation hépatique, notamment sous tacrolimus. Cet immunosuppresseur favorise une réponse Th2 avec production accrue d’IgE. Associé aux antibiotiques, il altère le microbiote intestinal et augmente la perméabilité digestive, facilitant la sensibilisation aux allergènes. Ce cas souligne l’importance d’un dépistage allergologique pré-greffe et d’un suivi étroit après transplantation. Une vigilance particulière doit être accordée aux manifestations cliniques atypiques, telles que les rectorragies, afin de ne pas méconnaître une cause allergique et d’optimiser la prise en charge.

食物过敏和药物过敏是儿科肝脏移植后日益被认识到的并发症，患病率高达54.3%。IgE介导的食物过敏通常表现为皮肤体征和胃肠道症状，如腹痛和腹泻，而最初的直肠症状仍然很少。我们报告了一个12个月大的女孩在9个月大时接受肝脏移植的原始病例。它表现为胆道萎缩，最初通过胆道-消化引流治疗，但没有成功，后来发展为复杂的肝细胞衰竭肝硬化，导致肝移植和他克莫司免疫抑制的建立。它举办了两届非常丰富的校长会议。过敏评估证实了IgE介导的鸡蛋过敏和出血性直肠炎与牛奶蛋白过敏相关。此外，口服刺激试验证实了对阿司匹林的过敏反应。治疗包括去除鸡蛋和牛奶的饮食，以及阿司匹林脱敏方案，在去除过敏原后立即产生临床改善。这些直肠疾病的发生可能是由于肝脏移植引起的免疫紊乱，特别是在他克莫司下。这种免疫抑制剂促进Th2反应，增加IgE的产生。与抗生素一起使用，它会改变肠道微生物群，增加消化通透性，促进对过敏原的敏感性。该病例强调了移植前过敏筛查和移植后密切监测的重要性。应特别注意非典型的临床表现，如直肠出血，以便不忽视过敏原因，并优化治疗。

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引用次数: 0

Syndrome d’entérocolite médicamenteuse induite par la ropivacaïne injectée par voie péri-nerveuse : premier cas rapporté 罗哌卡因神经周围注射引起的药物性小肠结肠炎综合征：首次报告病例

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-08-11 DOI: 10.1016/j.reval.2025.104586

J. Herry , C. Chassery , M. Virtos , D. Sabouraud , P. Beaumont , C. Ponvert

Rare cases of drug-induced enterocolitis syndrome have been reported with drugs administered by the oral (amoxicillin, pantoprazole) and intrarectal (paracetamol) routes. No cases have been described by injectable route. Diagnostic criteria, close to those of food protein-induced enterocolitis syndrome, have been proposed in 2019. We report the case of a 72-year-old patient scheduled for a total knee arthroplasty and recused on two occasions after rapid occurrence of drug-induced enterocolitis after peri-nervous injection of ropivacaine during a nerve block carried out before the surgery. Skin tests performed after the first reaction, according to EEACI/ENDA (European Academy of Allergy and Clinical Immunology) recommendations, were negative. The drug provocation test with ropivacaine was also negative. However, the symptoms recurred at the second anesthesia. A few cases of IgE-mediated hypersensitivity to local anesthetics have been reported, but, to our knowledge, this is the first case of drug-induced enterocolitis syndrome induced by an injectable drug, ropivacaine, recurring although skin tests and provocation test resulted negative.

经口服（阿莫西林，泮托拉唑）和直肠内（扑热息痛）途径给药的药物引起的肠结肠炎综合征的罕见病例已被报道。没有通过注射途径报告的病例。2019年提出了与食物蛋白性小肠结肠炎综合征相似的诊断标准。我们报告一例72岁的患者，原计划行全膝关节置换术，但在术前进行神经阻滞时，在神经周围注射罗哌卡因后，迅速发生药物性小肠结肠炎，两次被拒绝。根据EEACI/ENDA（欧洲过敏和临床免疫学学会）的建议，首次反应后进行的皮肤测试呈阴性。罗哌卡因激发试验也呈阴性。然而，第二次麻醉时症状复发。据报道，有几例ige介导的局部麻醉剂超敏反应，但据我们所知，这是第一例由注射药物罗哌卡因引起的药物性小肠结肠炎综合征，尽管皮肤试验和激发试验结果为阴性，但反复出现。

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引用次数: 0

Impact de la prise en charge multidisciplinaire sur le contrôle et l’évolution de l’asthme difficile 多学科护理对哮喘控制和进化的影响

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-08-11 DOI: 10.1016/j.reval.2025.104599

M. Oulad Kouider , A. Fissah , H. Madi , M.S. Aissani , K. Bouchbouch , K. Ouennoughi , A. Bachir Cherif , F. Zedam , L. Zemmour , S. Benzaoui , Z. Boukara , M. Kibboua , S. Alihalassa

Introduction

Although patients with severe asthma constitute only around 5% to 10% of asthmatic patients, they account for almost half of the costs related to this condition. This situation is related to the disease itself and its comorbidities.

Methods

This is a prospective observational study in the academic hospital of Blida in Algeria. Data were collected from May 2019 to November 2021. Only patients who met the criteria of severe asthma according to the definition GINA 2018. The included patients received a multidisciplinary approach along with personalized education.

Results

One hundred and fifty patients were included, and 65.3% of them were women. Among the patients, 93.3% had comorbidities, with chronic allergic rhinitis being the most common allergic comorbidity. Meanwhile, gastroesophageal reflux was the most prevalent non-allergic comorbidity (48.7%). After multidisciplinary care, only 27.3% of the participants continued to have severe asthma.

Conclusion

Patients with severe asthma require personalized education and the collaboration of different specialists.

虽然严重哮喘患者仅占哮喘患者的5%至10%，但他们的费用却几乎占到哮喘相关费用的一半。这种情况与疾病本身及其合并症有关。方法在阿尔及利亚Blida学术医院进行前瞻性观察研究。数据收集于2019年5月至2021年11月。根据GINA 2018的定义，只有符合严重哮喘标准的患者。纳入的患者接受多学科治疗和个性化教育。结果共纳入150例患者，女性占65.3%。93.3%的患者有合并症，慢性变应性鼻炎是最常见的过敏性合并症。同时，胃食管反流是最常见的非过敏性合并症（48.7%）。在多学科治疗后，只有27.3%的参与者继续患有严重哮喘。结论重症哮喘患者需要个性化教育和不同专科医师的配合。

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引用次数: 0

Assessing allergenicity of urban parks: Ordu City 城市公园致敏性评估：奥尔都市

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-08-05 DOI: 10.1016/j.reval.2025.104582

S. Türkiş , F.E. Günaydin

Higher average temperatures due to climate change tend to change the spatial and temporal distribution of pollens. The study area was conducted in the Urban Park areas of Ordu Province, where urban people spend the most time. In the last decade, various allergenicity indices such as Specific Allergenicity Index (SAI) and Urban Green Zone Allergenicity Index (IUGZA) have been proposed to control hypoallergenicity in urban areas. The study aimed to warn allergic individuals about the risk posed by pollens and evaluate the allergenicity of existing urban vegetation. Specific Allergenicity Index (SAI) and Urban Green Zone Allergenicity Indexes (IUGZA = 0.208) of 25 plant species spread in urban park areas were calculated. To determine these indices, life cycle, overlap-abundance values, height, pollination time, pollination process, allergenicity potential, and cross-reactivity values of the species were determined. Among the species, the species with the highest allergenic effect, i.e. both abundance and allergenic potential, is Corylus avellana var avellana. In terms of allergenic potential value (VPA), it is seen that C. avellana var. avellana, Alnus glutinosa, Cupressus sempervirens, Olea europae, Salix spp. and Acer spp. are the most effective species on the axes. The abundance of the species (0.802) was the factor that made the allergenic factors most effective. Determination of the urban allergenicity index of Ordu province to determine the ecological driving forces of the distribution of ecosystems is important in estimating the allergenicity index of urban green areas and in selecting the right species to minimize the allergenic in parks.

气候变化导致的平均气温升高往往会改变花粉的时空分布。研究区域是在Ordu省的城市公园区域进行的，那里是城市居民花费最多时间的地方。近十年来，人们提出了各种过敏原指数，如特异性过敏原指数（SAI）和城市绿区过敏原指数（IUGZA），以控制城市地区的低过敏原性。本研究旨在警示过敏个体花粉的风险，并评估现有城市植被的致敏性。计算了分布在城市公园区域的25种植物的特异性致敏性指数（SAI）和城市绿区致敏性指数（IUGZA = 0.208）。为了确定这些指标，测定了物种的生命周期、重叠丰度值、高度、授粉时间、授粉过程、致敏潜力和交叉反应性值。其中，致敏效应（即丰度和致敏潜力）最高的物种是Corylus avellana var avellana。从致敏潜值（VPA）来看，在轴上最有效的树种是黄樟（C. avellana var. avellana）、桤木（Alnus glutinosa）、柏树（perpressus sempervirens）、油橄榄（Olea europae）、柳树（Salix）和槭（Acer）。物种丰度（0.802）是使致敏因子最有效的因素。确定奥尔都省城市变应原指数，确定生态系统分布的生态驱动力，对于估算城市绿地的变应原指数和选择合适的物种以减少公园的变应原具有重要意义。

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引用次数: 0

De l’application de teinture capillaire à l’unité de soins intensifs : une réaction sévère à la para-phénylènediamine 从染发到重症监护室：对对苯二胺的严重反应

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-07-14 DOI: 10.1016/j.reval.2025.104584

F.Z. El Fatoiki, Z. Mouhsine, Y. Mahdar, F. Hali, S. Chiheb

Para-phenylenediamine (PPD), a common allergen in hair dyes and black henna tattoos, is typically responsible for allergic contact dermatitis and, rarely, systemic reactions like anaphylaxis. We report the case of a 22-year-old female with no significant medical history who developed pruritic eyelid edema and respiratory distress 24 hours after using a PPD-containing hair dye. She had prior exposure to black henna without issues. Clinical examination revealed erythematous plaques with vesicles and eyelid edema. Respiratory symptoms included dyspnea, tachycardia, and dysphonia. The patient required intensive care, receiving nebulized and intramuscular adrenaline, followed by corticosteroids. Patch testing confirmed a positive reaction to PPD. This case highlights the rare but possible coexistence of immediate and delayed hypersensitivity reactions to PPD, reflecting a complex and potentially severe immunologic mechanism. It emphasizes the importance of PPD regulation, patch testing for diagnosis, and prevention of repeated exposures.

对苯二胺（PPD）是染发剂和黑色指甲花纹身中常见的过敏原，通常会导致过敏性接触性皮炎，很少会引起过敏反应等全身性反应。我们报告一例22岁女性无明显病史，在使用含ppd的染发剂24小时后出现瘙痒性眼睑水肿和呼吸窘迫。她之前接触过黑色指甲花，没有问题。临床检查发现红斑斑块伴小泡及眼睑水肿。呼吸系统症状包括呼吸困难、心动过速和发音困难。患者需要重症监护，接受雾化和肌肉注射肾上腺素，随后使用皮质类固醇。斑贴试验证实对PPD有阳性反应。本病例强调PPD的即时和延迟超敏反应罕见但可能共存，反映了复杂且潜在严重的免疫机制。它强调了PPD调控、斑贴检测诊断和预防重复暴露的重要性。

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引用次数: 0

Réaction anaphylactique énigmatique au cabinet dentaire 牙科诊所的神秘过敏反应

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-07-11 DOI: 10.1016/j.reval.2025.104585

E. Seigle-Ferrand , M. Merveilleau , P. Bierme , C. Braun

We report the case of a young boy who was referred to us for suspected anaphylaxis to a local anesthetic during a dental procedure. Shortly after the administration of a local anesthesia using adrenaline-laced articaine, he developed a grade 2 anaphylactic reaction, which was treated with an intramuscular injection of adrenaline. Unable to test articaine (which was still mixed with adrenaline), we tested lidocaine as an alternative and then performed a subcutaneous provocation test, which did not elicit any reaction, allowing us to rule out a lidocaine allergy. However, our skin tests, performed after disinfection with chlorhexidine, were positive for latex, which we initially suspected to be responsible for the anaphylactic reaction. But a control prick-test on untreated skin, not disinfected with chlorhexidine, was negative. Upon further questioning, we discovered that the patient had used a mouthwash containing chlorhexidine immediately before the local anesthesia, which had not initially been mentioned either by the dentist or by the family. The chlorhexidine prick-test, as well as specific IgE testing, both returned positive, ultimately confirming sensitization to chlorhexidine. This was therefore an IgE-mediated allergy to chlorhexidine, likely due to mucosal absorption through the breach caused by the gingival local anesthesia. This case serves as a reminder of the need for a systematic and thorough approach in evaluating drug hypersensitivity. Allergy to chlorhexidine should always be considered when investigating perioperative anaphylaxis, even when the product is well tolerated on intact skin or mucous membranes.

我们报告的情况下，一个年轻的男孩谁被转介到我们的怀疑过敏反应，局部麻醉在牙科手术。在使用肾上腺素阿卡因局部麻醉后不久，他出现了2级过敏反应，并通过肌肉注射肾上腺素治疗。由于无法测试阿替卡因（仍与肾上腺素混合），我们测试了利多卡因作为替代品，然后进行了皮下激发试验，该试验没有引起任何反应，允许我们排除利多卡因过敏。然而，我们在用氯己定消毒后进行的皮肤试验显示乳胶阳性，我们最初怀疑乳胶是过敏反应的原因。但对未经处理、未用氯己定消毒的皮肤进行对照刺痛试验，结果为阴性。在进一步询问后，我们发现患者在局部麻醉前使用了含有氯己定的漱口水，而牙医和家属最初都没有提到这一点。氯己定针刺试验和特异性IgE试验均为阳性，最终证实对氯己定敏感。因此，这是一种ige介导的氯己定过敏，可能是由于牙龈局部麻醉引起的粘膜吸收裂口。这个病例提醒我们需要一个系统和彻底的方法来评估药物过敏。在调查围手术期过敏反应时，应始终考虑对氯己定过敏，即使该产品在完整的皮肤或粘膜上耐受性良好。

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引用次数: 0

Intérêt des patch tests dans l’exploration des réactions d’hypersensibilité retardée aux antiépileptiques 贴片测试在探索抗癫痫药物延迟过敏反应中的重要性

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-05-20 DOI: 10.1016/j.reval.2025.104568

I. Bouaziz, R. Atheymen, R. Sahnoun, K. Ksouda, H. Affes, S. Hammami, K. Zghal

Objective

The aim of our study was to evaluate the utility of the patch-tests for the diagnosis of the delayed hypersensitivity reactions induced by antiepileptic drugs and to explore cross-reactivity between them.

Patients and methods

We included cases of delayed drug addiction to antiepileptics notified to the Sfax regional pharmacovigilance center during the period from January 2019 to June 2023. We used the French Bégaud method for the study of imputability. Patch testing was performed in all patients according to the recommendations of the European Network of Drug Allergy. The interpretation of the results was made according to the rules of the International Contact Dermatitis Research Group.

Results

We included 17 delayed drug reactions: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome (n = 10), maculopapular rash (n = 6), Stevens-Johnson syndrome (n = 1). Patch tests were positive in 76.47% of cases: 66.66% for maculopapular rash with cross-reactivity between carbamazepine and phenobarbital (n = 1) and 90% in DRESS syndrome with cross-reactivity between 2 or more antiepileptics (n = 5). For the patient with Stevens-Johnson syndrome, the tests were interpreted as irritating.

Conclusion

Patch tests are safe and useful to confirm the imputability of antiepileptic drugs in the genesis of delayed drug hypersensibility reaction and to detect possible cross-reactivity.

目的评价贴片试验对抗癫痫药物致迟发性超敏反应的诊断价值，探讨两者间的交叉反应性。患者和方法纳入2019年1月至2023年6月期间向Sfax地区药物警戒中心报告的抗癫痫药物延迟药物成瘾病例。我们用法国的bsamgaud方法来研究归咎性。根据欧洲药物过敏网络的建议，对所有患者进行了斑贴试验。根据国际接触性皮炎研究小组的规则对结果进行解释。结果纳入17例迟发性药物反应：伴嗜酸性粒细胞增多及全身症状的药物性皮疹（DRESS）综合征（n = 10）、黄斑丘疹（n = 6）、Stevens-Johnson综合征（n = 1）。斑贴试验阳性的病例占76.47%：卡马西平与苯巴比妥交叉反应的黄斑丘疹病例占66.66% (n = 1)， DRESS综合征病例占90% (n = 5)， 2种及以上抗癫痫药物交叉反应（n = 5）。对于史蒂文斯-约翰逊综合征患者来说，这些测试被认为是刺激的。结论斑贴试验可安全、有效地确定抗癫痫药物在迟发性药物超敏反应发生中的归责关系，并可检测可能的交叉反应。

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引用次数: 0

La téléexpertise en allergologie 过敏症的远程专业知识

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-05-20 DOI: 10.1016/j.reval.2025.104569

E. Seve , V. Baggio , M. Hosotte , J. Herry , N. Guerzider , C. Palussière , W. Assemat

Teleexpertise is a recent telemedicine tool for communicating between healthcare professionals about a patient's problem, in a secure and asynchronous manner. We studied data from a platform, Omnidoc©, on all allergology activity during the first half of 2024, i.e. 444 procedures, and on data from the 5 most active allergists. An allergist performs on average one TE per month with a response time of less than 48 hours. Opinions are mainly requested by general practitioners, for stories of skin rashes or suspected drug allergies. However, uses vary greatly from one doctor to another.

远程诊断是一种最新的远程医疗工具，用于在医疗保健专业人员之间以安全和异步的方式就患者的问题进行通信。我们研究了来自Omnidoc©平台的数据，该数据涉及2024年上半年的所有过敏症活动，即444例手术，以及来自5名最活跃的过敏症专家的数据。过敏症专科医生平均每月进行一次TE治疗，反应时间少于48小时。对于出现皮疹或疑似药物过敏的病例，主要由全科医生提出意见。然而，不同医生的用法差别很大。

引用次数: 0

Allergie croisée entre paclitaxel et éribuline ? 对紫杉醇和艾比林过敏？

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-05-20 DOI: 10.1016/j.reval.2025.104581

M. Delin , H. Gadoin , E. Ewig , F. Rocher-Moreau , L. Lipszyc , L. Thomas , A. Creisson , B. Gerard , S. Leroy

Background

Eribulin is a drug that is currently used in metastatic breast cancer as an alternative to taxanes. No allergy has been described yet to this molecule.

Patients and methods

We described two cases in France that present delayed allergy to eribulin after a first cycle. Both of patients received paclitaxel before.

Results

A possible cross-allergy to eribulin with paclitaxel is possible. Our case describes skin testing to eribulin.

Conclusions

Cross-allergy between paclitaxel and eribulin is conceivable. This would be a rare undesirable effect, but one that requires particular attention. The mode of action of these two molecules (inhibition of microtubules) could provide a pathophysiological explanation.

黄嘌呤是一种目前用于转移性乳腺癌的药物，作为紫杉烷的替代品。目前还没有人对这种分子过敏。患者和方法我们描述了法国的两个病例，在第一个周期后出现对伊瑞布林的延迟过敏。两例患者均曾接受紫杉醇治疗。结果伊瑞布林与紫杉醇可能存在交叉过敏。我们的病例描述了对伊瑞布林的皮肤试验。结论紫杉醇与伊瑞布林存在交叉过敏。这将是一种罕见的不良影响，但需要特别注意。这两种分子的作用方式（抑制微管）可以提供病理生理学解释。

引用次数: 0

L’angiœdème à travers les âges : considérations pratiques 老年性血管水肿：实际考虑

IF 0.3 4区医学

Revue Francaise d Allergologie

Pub Date : 2025-05-20 DOI: 10.1016/j.reval.2025.104583

A. Bocquet , C. Hoarau , L. Carriat , L. Bouillet , S. Guez , I. Boccon-Gibod , N. Marmion

Challenges associated with angioedema differ with patient's age. In children, the most frequent one is bradykinin-related hereditary angioedema (HAE). Diagnosis might be difficult when signs and symptoms are not evocative, such as isolated abdominal crises, in the absence of familial context. Management by multidisciplinary team should be organized rapidly, preferably in an expert center, to allow children living a normal life and experiencing satisfactory development. Adolescence, often characterized by an increase in frequency and severity of crises, must be the period of patient's empowerment in disease management. But it is also a period of instability and turbulences with a possible decreased compliance to treatment. Contraception must be discussed in young female patients due to the relationship between estrogen secretion and HAE attacks. In adults, follow-up and treatment are pursued without any remarkable feature. If HAE appears during adulthood, differential diagnoses should be considered, such as acquired C1 inhibitor deficiency, and associated hemopathies should be detected (monoclonal gammopathy or lymphoproliferative syndrome). Pregnancy requires increased surveillance because of specific risks arising in this situation. Finally, in elderly patients, preexisting HAE is often associated with other comorbidities that can interfere with its evolution, especially because of drug intake. Attacks management may become more difficult and compliance may decrease. Occurrence of HAE after 65 years of age being exceptional, it is important to diagnose iatrogenic angioedema (related in particular to conversion enzyme inhibitors) or thrombolysis of a stroke.

与血管性水肿相关的挑战因患者年龄而异。在儿童中，最常见的是缓激素相关的遗传性血管性水肿（HAE）。当体征和症状不能唤起时，诊断可能是困难的，例如孤立的腹部危象，在没有家族背景的情况下。应迅速组织多学科团队管理，最好在专家中心进行管理，使儿童过上正常的生活，获得满意的发展。青春期往往以危机的频率和严重程度增加为特征，必须是病人在疾病管理方面获得授权的时期。但这也是一个不稳定和动荡的时期，可能会降低对治疗的依从性。由于雌激素分泌与HAE发作之间的关系，年轻女性患者必须讨论避孕。在成人中，随访和治疗没有任何显著特征。如果HAE在成年期出现，应考虑鉴别诊断，如获得性C1抑制剂缺乏，并应检测相关血液病（单克隆γ病或淋巴增生性综合征）。怀孕需要加强监测，因为在这种情况下会产生特定的风险。最后，在老年患者中，先前存在的HAE通常与其他合并症有关，这些合并症会干扰其发展，特别是由于药物摄入。攻击管理可能会变得更加困难，遵从性可能会降低。65岁以后发生HAE的情况很少见，因此诊断医源性血管性水肿（特别是与转化酶抑制剂有关）或卒中溶栓是很重要的。

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引用次数: 0