(Anaphylaxis)

(anaphylaxis)

Anaphylaxis
(immediate systemic reaction) 1

anaphylaxis anaphylaxis
(underdiagnosis)

( ICD-9CM)
(life time prevalence) 0.05 2 2
anaphylaxis
15 15
2 anaphylaxis 3
4
anaphylaxis 0.02 - 0.03
5, 6
anaphylaxis 0.65 7

anaphylaxis IgE (IgEmediated type I hypersensitivity) IgE

IgE receptor mast cells basophils

anaphylaxis
219

 (immunologic mechanism)
Immunoglobulin
autoimmune
(non-immunologic mechanism)
anaphylaxis anaphylactoid mast cells
basophils IgE
opioids vancomycin
anaphylaxis
mast cells basophils8

9
1. Anaphylactic ( IgE)

2. Anaphylactoid ( mast cells basophils IgE)

(radiocontrast media) NSAIDs, opioids
Immunoglobulin (IVIG) dextran

3. (idiopathic anaphylaxis) anaphylaxis

1 3 anaphylaxis 10

anaphylaxis

anaphylaxis


stridor wheezing

220


(tachycardia) (bradycardia)

94
88 21
22 11
(biphasic reactions)
1 20
epinephrine
8 72
24 48 12
(Anaphylaxis) 1
anaphylaxis 1 3
1. ( )

. stridor
peak expiratory flow (PEF)
. (endorgan dysfunction) )
2. (a likely allergen)
2
.
.
.
. (crampy abdominal pain)

3. (known allergen)
. systolic (systolic blood pressure) ()
30 systolic
. systolic 90 .
30 systolic

221


anaphylaxis
vaso-vagal reaction

(myocardia dysfunction) (pulmonary embolism)

(angioedema) (hyperventilation syndrome)

13

anaphylaxis
Serum or plasma total tryptase levels mast cells
15 180
anaphylaxis anaphylaxis
1 2
14
anaphylaxis
anaphylaxis IgE skin prick test (
) specific IgE
anaphylaxis
anaphylaxis
25%
60%

anaphylaxis oral food challenge

-lactams specific IgE
1

1. (airway, breathing and circulation)

2. epinephrine 1:1,000 0.01 mL/kg 0.3 mL
0.5 mL (anterolateral side of
222

thigh) 15 5 - 15

3.
4.
5. ( empty
ventricle symdrome)
6. H1 antihistamines first second generation
H2-antihistamines
hydrocortisone 5 mg/kg/dose 6 anaphylaxis
(biphasic reactions) 24 48
2-agonist nebulizer
glucagon epinephrine
7. 24 48
anaphylaxis
1. epinephrine anaphylaxis


2.
3.
mastocytosis -blockers

4. anaphylaxis
anaphylaxis (exercisetriggered anaphylaxis)

5. (immunomodulation)
(immunotherapy)
desensitization -lactams

223

 1 anaphylaxis

epinephrine

epinephrine 5 15
3 5

H1
H2 antihistamines

2-agonist
nebulizer

24 48

-blockers
/ atropine

* Lieberman P. Anaphylaxis. Med Clin N Am 2006; 90: 77-95.

224

blockers

1. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second
symposium on the definition and management of anaphylaxis: summary report-Second National
Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J
Allergy Clin Immunol 2006; 117: 391-7.
2. Lieberman P, Camargo CA Jr, Bohlke K, Jick H, Miller RL, Sheikh A, et al. Epidemiology of
anaphylasis: findings of the American Clooege of Allergy, Asthma and Immunology Epidemiology
of Anaphylaxis Working Group. Ann Allergy Asthma Immunol 2006; 97: 596-602.
3. Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to
food, 2001-2006. J Allergy Clin Immunol 2007; 119: 1016-8.
4. Greenberger PA, Rotskoff BD, Lifschultz B. Fatal anaphylaxis: postmortem findings and associated
comorbid diseases. Ann Allergy Asthma Immunol 2007; 98:252-7.
5. Jirapongsanuruk O, Bunsawansong W, Piyaphanee N, Visitsunthorn N, Thongngarm T, Vichyanond
P. Ann Allergy Asthma Immunol 2007; 98(2): 157-62.
6. Poachanukoon O, Paopairochanakorn C. Asian Pac J Allergy Immunol 2006; 24(2-3): 111-6.
7. Janwitayanujit S. Anaphylaxis. J med Assoc Thai 2007; 90(1): 195-200.
8. Simons FER. Anaphylaxis. J Allergy Clin Immunol 2008;121: S402-7.
9. Kemp SF, Lockey RF. Anaphylaxis: A review of causes and mechanisms. J Allergy Clin Immunol
2002; 110: 341-8.
10. Curr Opin Allergy Clin Immunol 2003
11. Bohlke K, Davis RL, DeStefano F, et al. Epidemiology of anaphylaxis among children and
adolescents enrolled in a health maintenance organization. J Allergy Clin Immunol 2004; 113: 53642.
12. Lieberman P. Anaphylaxis. Med Clin N Am 2006; 90: 77-95.
13. Oswalt ML, Kemp SF. Anaphylaxis: office management and prevention. Immunol Allergy Clin N
Am 2007; 27: 177-91.
14. Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin
North Am 2006; 26: 451-63.
15. Simons E. Epinephrine in the first-aid out-of-hospital treatment of anaphylaxis. In: Anaphylaxis.
London: John Wiley & Sons; 2004. p. 228-43.

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