在大腿深的河里玩耍时冷致过敏性休克：一例儿科病例

IF 1.1 Q4 ALLERGY Journal of Cutaneous Immunology and Allergy Pub Date : 2022-10-24 DOI:10.1002/cia2.12285

Ayumi Sakai MD, Naoko Inomata MD, PhD, Kohei Yamakawa MD, Yukie Yamaguchi MD, PhD

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摘要

获得性冷性荨麻疹(ACU)是一种以局部皮肤反应为特征的物理荨麻疹。据报道，ACU患者在局部冷暴露后发生全身反应，最常见的是完全浸入冷水，但很少由局部接触冷水或冰引起一个四岁的小女孩抱怨夏天在河边玩耍时浑身发痒。水深及大腿，她的腿完全浸在水里，浑身都被水淹了(图1)。她的脸和嘴唇发紫，失去了知觉，最终无法动弹。不久，她的父母把她从水里捞出来，给她加热，症状逐渐消失。没有昆虫叮咬的迹象，发作前也没有吃过不寻常的食物。她拿着冰淇淋甜筒时手发痒，吃冰淇淋时舌头肿胀。没有盗汗、头痛、关节痛或发烧的发作。既往无其他内科疾病，家族史无特应性疾病或寒性荨麻疹。在实验室检查中，血清总IgE水平为32 IU/ml，未检测到冷球蛋白。使用冷刺激装置TempTest®4.0 (Emo Systems GmbH, Berlin, Germany)进行冷刺激试验，在4 - 17°C下诱发车轮，在4 - 19°C下诱发红斑(图1)。因此，患者被诊断为原发性ACU, CTT估计为17°C。在CTT为17°C的基础上，我们指导她保持皮肤温度在20°C以上，基本避免寒冷的环境和食物。此外，我们允许她在炎热的天气在室内温水和室外游泳池游泳不到30分钟，并开抗组胺药预防症状。ACU在人群中的患病率为0.05%，发病年龄多在2 ~ 4岁据报道，儿科发病病例比成人发病病例更容易出现全身反应(25% vs 16.7%)Alangari等人4报道，30名ACU儿童中有11名(36.7%)出现了全身反应，主要是由水生活动引发的，这可能涉及长时间暴露在较宽的体表区域。在以往的病例报告中，大多数全身性症状是由游泳或全身暴露的寒冷环境引发的。我们的病例比之前报道的局部暴露于冷水引发全身反应的病例年轻，后者的年龄为6.5岁。在寒冷性荨麻疹治疗中，根据个体患者的严重程度避免冷刺激是预防全身反应的必要条件。传统的冰块测试无法评估CTT，导致避免所有冷暴露的统一指令。最近，TempTest®被推荐在荨麻疹指南中，为ACU患者制定个性化的治疗计划ACU患者在广泛的冷暴露中可能涉及全身性反应，有时患者不到一半的身体暴露在冷水中。这些知识对于临床医生帮助患者避免危及生命的情况是不可避免的。此外，CTT的评估应考虑更好的患者自我管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Cold-induced anaphylactic shock during playing in a thigh-deep river: A pediatric case

We report a pediatric patient with acquired cold urticaria who developed a systemic reaction triggered by localized cold exposure. By determining the critical threshold temperature using TempTest®, we were able to minimize restriction in activities.

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