Audrey Kamga, Jean Luc Bourrain, Pascal Demoly, Luciana Kase Tanno
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引用次数: 0
Abstract
Purpose of review: This review aims to identify phenotypes at-risk of Hymenoptera venom-induced anaphylaxis (HVA), focusing on different perspectives (epidemiological, clinical, and therapeutic) in order to adapt future preventive strategies.
Recent findings: HVA remains one of the leading causes of anaphylaxis, with a broad pattern of symptoms. Although most cases occur outside healthcare settings, data indicate a high emergency admission rate due to insect stings. Mortality is often underestimated because of the lack of witnesses and difficulties in recognizing the signs and the culprit. Targeting risk factors could be a clue to improve these statistics and the prognosis of the disease.Potential risk factors for severe HVA in the European population are basal serum tryptase (BST) above 8 μg, mast cell disorders, the absence of skin symptoms, and cardiovascular conditions requiring the use of beta blockers and ACE inhibitors. Identifying these criteria, mainly based on clinical patterns, helps to develop personalized strategies for management and prevention.
Summary: With a personalized medicine approach, phenotypes must be characterized to adapt to the management of patients suffering from Hymenoptera venom anaphylaxis (HVA), including venom immunotherapy (VIT). In this systematic review, all articles mentioned systemic reactions with heterogeneous severity degrees. Half of those reported grade III-IV systemic reactions (Ring and Messmer). HVA clinical patterns could be worsened by one Hymenoptera sting, a patient's history with mast cell disorders, or cardiovascular diseases. VIT failure was attributed to bee venom extract and monotherapy in two-thirds of publications. Findings stress the difficulty of having uniform epidemiological data on HVA and the lack of financial support in some world regions to support appropriate management of these conditions. Although observing a heterogeneity of data, we were able to identify potential risk factors, in particular for the severe cases. We believe our work will support allergists and health professionals to implement improved personalized management of patients suffering from severe HVA.
综述的目的:本综述旨在从不同角度(流行病学、临床和治疗)确定有可能患膜翅目昆虫毒液诱发过敏性休克(HVA)的表型,以便调整未来的预防策略:HVA 仍是过敏性休克的主要病因之一,其症状模式十分广泛。尽管大多数病例发生在医疗机构之外,但数据显示,昆虫蛰伤导致的急诊入院率很高。由于缺乏目击者以及难以识别症状和罪魁祸首,死亡率往往被低估。在欧洲人群中,严重 HVA 的潜在风险因素包括基础血清胰蛋白酶 (BST) 超过 8 μg、肥大细胞疾病、无皮肤症状以及需要使用β受体阻滞剂和 ACE 抑制剂的心血管疾病。摘要:在个性化医疗方法中,必须对表型进行描述,以适应对绣线菊毒液过敏性休克(HVA)患者的管理,包括毒液免疫疗法(VIT)。在本系统综述中,所有文章都提到了严重程度不一的全身反应。其中半数报告了 III-IV 级全身反应(Ring 和 Messmer)。HVA 的临床模式可能会因一次被膜翅目昆虫蜇伤、患者有肥大细胞疾病史或心血管疾病而恶化。三分之二的出版物将 VIT 失败归咎于蜂毒提取物和单一疗法。研究结果表明,很难获得统一的 HVA 流行病学数据,而且世界上一些地区缺乏财政支持,无法对这些病症进行适当的管理。尽管观察到的数据不尽相同,但我们还是能够确定潜在的风险因素,尤其是严重病例的风险因素。我们相信,我们的工作将有助于过敏学家和医疗专业人员对严重 HVA 患者实施更好的个性化管理。
期刊介绍:
This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on one to three topics, every issue of Current Opinion in Allergy and Clinical Immunology delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as upper airway disease; mechanisms of allergy and adult asthma; paediatric asthma and development of atopy; food and drug allergies; and immunotherapy.