最近对过敏反应的流行病学和管理的见解。

IF 3.8 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Balkan Medical Journal Pub Date : 2025-09-01 Epub Date: 2025-07-28 DOI:10.4274/balkanmedj.galenos.2025.2025-5-86
Sakura Sato, Tsuyoshi Kodachi, Noriyuki Yanagida, Motohiro Ebisawa
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引用次数: 0

摘要

过敏反应是一种严重的、迅速发展的全身性超敏反应,如果不及时发现和治疗,可能危及生命。它的全球发病率正在上升,尤其是在儿童中,尽管致命的结果仍然不常见。本文综述了目前对过敏反应的理解,包括其流行病学,诱因,急性管理和长期预防策略,重点是由食物,药物和昆虫叮咬引起的病例。估计终生过敏反应发生率在0.05%至2%之间。对儿童来说,食物是主要诱因,而对成年人来说,药物是最常见的诱因。食物相关过敏反应的罪魁祸首因地区而异:在西方国家,花生和树坚果占主导地位;在东亚,鸡蛋和牛奶是最常见的;在东南亚,海鲜是主要原因。药物性过敏——通常是世界范围内过敏性反应相关死亡的主要原因——由于化疗和生物制剂的使用越来越多,正在增加。昆虫叮咬约占所有病例的10%,并且仍然是致死性过敏反应的最常见原因。肌内注射肾上腺素仍然是主要的治疗方法,但其施用往往被延迟或使用不足。患者应在最初反应后开肾上腺素自身注射器,但各国的可用性和使用率差异很大。对患者和护理人员进行教育以及制定明确的行动计划至关重要。正在开发新的替代方案,如鼻内和舌下肾上腺素装置,以改善获取途径并尽量减少治疗中的犹豫。在预防方面,VIT已经建立并非常有效,在90%以上的病例中可以预防全身反应。药物脱敏使必要药物的安全管理,尽管确认过敏,这种方法适用于所有年龄,包括儿童。针对食物过敏原的口服免疫疗法可以提高某些患者的耐受水平,降低意外暴露的机会,但安全问题限制了其广泛使用。生物疗法如omalizumab为多种食物或药物过敏患者提供了新的治疗途径。最近的研究表明,omalizumab可以提高儿童对花生和其他过敏原的反应阈值。病例报告还表明,它可以提高药物脱敏期间的安全性,包括化疗。在诊断、应急准备、免疫疗法和生物制剂方面的持续进展继续扩大了管理过敏反应的选择范围。然而,在获取、认识和支持性证据方面的差距,特别是在儿童和老年人方面,突出表明需要进行更多的研究和卫生系统投资。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Recent Insights into the Epidemiology and Management of Anaphylaxis

Anaphylaxis is a severe, rapidly developing systemic hypersensitivity reaction that can be life-threatening if not promptly identified and treated. Its global incidence is on the rise, especially among children, though fatal outcomes remain uncommon. This review summarizes the current understanding of anaphylaxis, covering its epidemiology, triggers, acute management, and strategies for long-term prevention, with emphasis on cases caused by food, medications, and insect stings. The estimated lifetime prevalence of anaphylaxis ranges from 0.05% to 2%. In children, food is the primary trigger, whereas in adults, medications are the most commonly responsible. The main culprits for food-related anaphylaxis differ by region: in Western countries, peanuts and tree nuts predominate; in East Asia, hen’s eggs and cow’s milk are most frequent; and in Southeast Asia, seafood is the leading cause. Drug-induced anaphylaxis-often the main cause of anaphylaxis-related deaths worldwide-is increasing due to the growing use of chemotherapies and biologic agents. Insect stings cause about 10% of all cases and remain the most common cause of fatal anaphylaxis. Intramuscular adrenaline continues to be the primary treatment, yet its administration is often delayed or insufficiently used. Patients should be prescribed adrenaline autoinjectors following an initial reaction, but availability and usage rates differ widely across countries. Education for patients and caregivers and the creation of clear action plans are essential. New alternatives, such as intranasal and sublingual adrenaline devices, are being developed to improve access and minimize hesitation in treatment. For prevention, VIT is well established and highly effective, preventing systemic reactions in over 90% of cases. Drug desensitization enables safe administration of necessary medications despite confirmed allergies, and this approach is suitable for all ages, including children. Oral immunotherapy for food allergens can increase tolerance levels and lower the chance of accidental exposure in selected patients, though safety concerns limit its widespread use. Biologic therapies like omalizumab present new treatment avenues for patients with multiple food or drug allergies. Recent studies have shown that omalizumab can raise the threshold for reactions to peanuts and other allergens in children. Case reports also indicate it may improve safety during drug desensitization, including for chemotherapy. Ongoing progress in diagnosis, emergency readiness, immunotherapies, and biologics continue to broaden the range of options for managing anaphylaxis. Nonetheless, gaps in access, awareness, and supporting evidence-particularly for children and older adults-underscore the need for additional research and health system investment.

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来源期刊
Balkan Medical Journal
Balkan Medical Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
4.10
自引率
6.70%
发文量
76
审稿时长
6-12 weeks
期刊介绍: The Balkan Medical Journal (Balkan Med J) is a peer-reviewed open-access international journal that publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports and clinical images, invited reviews, editorials, letters, comments and letters to the Editor including reports on publication and research ethics. The journal is the official scientific publication of the Trakya University Faculty of Medicine, Edirne, Turkey and is printed six times a year, in January, March, May, July, September and November. The language of the journal is English. The journal is based on independent and unbiased double-blinded peer-reviewed principles. Only unpublished papers that are not under review for publication elsewhere can be submitted. Balkan Medical Journal does not accept multiple submission and duplicate submission even though the previous one was published in a different language. The authors are responsible for the scientific content of the material to be published. The Balkan Medical Journal reserves the right to request any research materials on which the paper is based. The Balkan Medical Journal encourages and enables academicians, researchers, specialists and primary care physicians of Balkan countries to publish their valuable research in all branches of medicine. The primary aim of the journal is to publish original articles with high scientific and ethical quality and serve as a good example of medical publications in the Balkans as well as in the World.
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