今日の臨床サポート

ハチ刺傷

著者: 石井道人 医療法人ミチテラス ファミリークリニックあざみ野

監修: 箕輪良行 みさと健和病院 救急総合診療研修顧問

著者校正/監修レビュー済:2021/04/14
患者向け説明資料

概要・推奨   

  1. 症状は大きく「局所反応」、「全身反応(アナフィラキシー)」、「毒液による中毒」、「二次感染」に分けられる。
  1. 全身反応を来した患者には、免疫療法が勧められる(推奨度1
  1. LLRを生じた患者には、免疫療法は必ずしも必要ではない(推奨度3)
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要
  1. 閲覧にはご契約が必要となります。閲覧にはご契
  1. 閲覧にはご契約が必要となります。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要とな
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
石井道人 : 特に申告事項無し[2021年]
監修:箕輪良行 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行った(変更なし)。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. ハチ刺傷によるわが国での死亡者数は年間30人前後で推移している[1]。被害は夏期に集中し、アウトドアや林業での被害報告が多い。脳卒中や心疾患による突然死と誤診されている可能性もあり、実際の犠牲者数はさらに多いものと思われる。
  1. ハチ刺傷の0.3~3%がアナフィラキシーに至る[2][3][4]。重症例は中高年に多く、機序は不明だが小児の重症化は少ない。
  1. 毒液そのものによる中毒は、数十~数百回分の刺傷を同時に受けた場合以外では問題とならない。問題となるのは毒液に対するⅠ型アレルギー反応である。
  1. 特に「毒液アレルギー」を持つ患者が刺された場合に重症化する。「毒液アレルギー」を持つ者は高率に全身反応を来す[5][6]
  1. ハチ刺傷時のアナフィラキシーリスクと免疫療法の必要性:<図表>
  1. ハチ特異的IgE抗体の保有率、皮膚テスト陽性率は一般人口の25~30%とされる[7][8]。「毒液アレルギー」を持つ患者は高率にハチ特異的IgE抗体を保有し、皮膚テストで陽性となることが多いが、頻度は不明である。
  1. ハチ毒によりアナフィラキシーに至った場合、アドレナリンの頻回投与に抵抗し難治となることがある[9][10]
 
  1. 小児では皮膚症状を越える全身反応がみられた場合に限り、免疫療法を勧める(推奨度2)
  1. まとめ:小児の場合、皮膚を越す全身反応がみられた患者では2度目の刺傷で30%が同様の症状を来す[27]
    一方で皮膚症状にとどまる全身症状は小児の場合多くにみられ、2度目の刺傷で重症化することが少ないとされる[28]
  1. 代表事例:一度ハチ刺傷により全身反応を来した小児患者を、免疫療法施行群と非施行群に分けた。再度刺傷された患児について、治療群は有意に全身反応の率が低かった(1.2%vs9.2%、p<0.001)。非治療群の患児でも2度目の刺傷はほとんど1度目より軽症であった。
 
  1. 毒液による直接の中毒症状が出現することはまれである。
  1. まとめ:毒液の中毒では嘔吐、下痢、頭痛、めまいなどを生じる。溶血、腎不全、横紋筋融解に至ることもある[29]
    ただし通常は刺されても数カ所なので毒量が少量にとどまり、症状を来すことはない[30]。発症した場合毒液を中和しうる特異的な抗体などはない。
  1. 代表事例:20匹以上に同時に刺され、腎不全を来した症例報告がある[31]
    LD50(半数致死量)は75kgで1,500回の刺傷とされる[32]
 
  1. 毒液アレルギーの遺伝性については未解明である。
  1. まとめ:ハチの毒液アレルギーに遺伝的傾向があるかはわかっていない。
  1. 代表事例:1割の患者に家族歴があったとする報告と、HLA-typingの結果まったく無関係であるという相反する報告がある[34][35]
問診・診察のポイント  
  1. 刺傷痕でハチの種類を判別するのは難しい。ただし種類の同定は免疫療法を行う際に役立つ可能性があり、できるかぎり問診で同定できるよう努める。人口密集地域では巣の存在は大きな脅威となる。予防、公衆衛生上の観点から、営巣の有無も確認する。

今なら12か月分の料金で14ヶ月利用できます(個人契約、期間限定キャンペーン)

11月30日(火)までにお申込みいただくと、
通常12ヵ月の使用期間が2ヶ月延長となり、14ヵ月ご利用いただけるようになります。

詳しくはクリック
本サイトの知的財産権は全てエルゼビアまたはコンテンツのライセンサーに帰属します。私的利用及び別途規定されている場合を除き、本サイトの利用はいかなる許諾を与えるものでもありません。 本サイト、そのコンテンツ、製品およびサービスのご利用は、お客様ご自身の責任において行ってください。本サイトの利用に基づくいかなる損害についても、エルゼビアは一切の責任及び賠償義務を負いません。 また、本サイトの利用を以て、本サイト利用者は、本サイトの利用に基づき第三者に生じるいかなる損害についても、エルゼビアを免責することに合意したことになります。  本サイトを利用される医学・医療提供者は、独自の臨床的判断を行使するべきです。本サイト利用者の判断においてリスクを正当なものとして受け入れる用意がない限り、コンテンツにおいて提案されている検査または処置がなされるべきではありません。 医学の急速な進歩に鑑み、エルゼビアは、本サイト利用者が診断方法および投与量について、独自に検証を行うことを推奨いたします。

文献 

著者: Hugh A Sampson, Anne Muñoz-Furlong, Ronna L Campbell, N Franklin Adkinson, S Allan Bock, Amy Branum, Simon G A Brown, Carlos A Camargo, Rita Cydulka, Stephen J Galli, Jane Gidudu, Rebecca S Gruchalla, Allen D Harlor, David L Hepner, Lawrence M Lewis, Phillip L Lieberman, Dean D Metcalfe, Robert O'Connor, Antonella Muraro, Amanda Rudman, Cara Schmitt, Debra Scherrer, F Estelle R Simons, Stephen Thomas, Joseph P Wood, Wyatt W Decker
雑誌名: J Allergy Clin Immunol. 2006 Feb;117(2):391-7. doi: 10.1016/j.jaci.2005.12.1303.
Abstract/Text There is no universal agreement on the definition of anaphylaxis or the criteria for diagnosis. In July 2005, the National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network convened a second meeting on anaphylaxis, which included representatives from 16 different organizations or government bodies, including representatives from North America, Europe, and Australia, to continue working toward a universally accepted definition of anaphylaxis, establish clinical criteria that would accurately identify cases of anaphylaxis with high precision, further review the evidence on the most appropriate management of anaphylaxis, and outline the research needs in this area.

PMID 16461139  J Allergy Clin Immunol. 2006 Feb;117(2):391-7. doi: 10.・・・
著者: Yael Graif, Orly Romano-Zelekha, Irit Livne, Manfred S Green, Tamy Shohat
雑誌名: J Allergy Clin Immunol. 2006 Jun;117(6):1435-9. doi: 10.1016/j.jaci.2006.03.004. Epub 2006 May 2.
Abstract/Text BACKGROUND: Insect sting allergy is a medical condition the magnitude of which has not been fully estimated in children.
OBJECTIVES: We sought to evaluate the prevalence of insect stings among schoolchildren in Israel, the rate of allergic reactions, and hospital attendance.
METHODS: A self-report questionnaire of the International Study of Asthma and Allergies in Childhood was administered to a national sample of schoolchildren aged 13 to 14 years across Israel. Questions regarding insect stings, allergic reactions, and hospital attendance were added.
RESULTS: Ten thousand twenty-one questionnaires were available for analysis. Most (56.3%) had been stung at least once in their lifetime. Of these, 20.5% had a large local reaction (LLR), 11.6% had a mild (cutaneous) systemic reaction (MSR), and 4.4% had a moderate-to-severe systemic reaction (SSR); 11.5%, 6.5%, and 2.5% of the study group, respectively. Arabs had significantly more allergic reactions of all 3 types than Jews (P < .0001). On multivariate analysis, LLR was associated with SSR (odds ratio, 6.25; 95% CI, 4.66-8.41) and MSR (odds ratio, 5.15; 95% CI, 4.24-6.25). More than 10% of the children with an LLR only attended a hospital compared with 7.5% of those with an MSR only and 14.5% with an SSR only.
CONCLUSIONS: The frequency of reported allergic sting reactions in children might be higher than previously estimated. Arab children reported significantly more allergic reactions than Jews. Hospital attendance does not correlate with the severity of the allergic reaction, and only a minority of children with SSRs are treated in hospital.
CLINICAL IMPLICATIONS: The improper care of severe reactions highlights the need for better public and physician education.

PMID 16751010  J Allergy Clin Immunol. 2006 Jun;117(6):1435-9. doi: 10・・・
著者: David B K Golden
雑誌名: Immunol Allergy Clin North Am. 2007 May;27(2):261-72, vii. doi: 10.1016/j.iac.2007.03.008.
Abstract/Text Anaphylaxis to insect stings has occurred in 3% of adults and can be fatal even on the first reaction. Large local reactions are more frequent but rarely dangerous. The chance of a systemic reaction to a sting is low (5% to 10%) in large local reactors and in children with mild (cutaneous) systemic reactions, and varies between 25% and 70% in adults depending on the severity of previous sting reactions. Venom skin tests are most accurate for diagnosis, but the radioallergosorbent test (RAST) is an important complementary test. The degree of sensitivity on skin test or RAST does not predict the severity of a sting reaction reliably. Venom sensitization can be detected in 25% of adults, so the history is most important. Venom immunotherapy is 75% to 98% effective in preventing sting anaphylaxis. Most patients can discontinue treatment after 5 years, with very low residual risk of a severe sting reaction.

PMID 17493502  Immunol Allergy Clin North Am. 2007 May;27(2):261-72, v・・・
著者: D F Graft, K C Schuberth, A Kagey-Sobotka, K A Kwiterovich, Y Niv, L M Lichtenstein, M D Valentine
雑誌名: J Pediatr. 1984 May;104(5):664-8.
Abstract/Text Large local reactions are a frequent occurrence after insect stings. We prospectively studied the demography, immunology, and significance of these reactions in the pediatric age group. Most children (83%) who have had large local reactions have positive skin test results to one or more venoms. Elevated amounts of venom-specific IgE antibody are usually present. Over 3 to 5 years, allergic sensitivity declines, as evidenced by less positive skin test results and lower levels of antivenom IgE antibodies. Most significantly, of 113 repeat stings, only 2% resulted in a systemic reaction.

PMID 6716215  J Pediatr. 1984 May;104(5):664-8.
著者: P M Mauriello, S H Barde, J W Georgitis, R E Reisman
雑誌名: J Allergy Clin Immunol. 1984 Oct;74(4 Pt 1):494-8.
Abstract/Text In ongoing studies of the natural history of stinging-insect allergy, 133 patients with large local reactions have been evaluated over 8 yr; 79 patients returned for reevaluation. Based on RAST analysis with honeybee and vespid venoms, patients were divided into RAST-positive and RAST-negative groups. Sixty-six patients were RAST-negative with positive venom skin tests in 58%. Seventy-five testings in this group led to no systemic reactions and 74 large local reactions. At follow-up RASTs remained negative, and the incidence of positive skin tests was unchanged. Sixty-seven patients had detectable serum venom-specific IgE covering a wide range in antibody titers, indistinguishable from patients with systemic reactions. Twenty-four of 67 patients received venom immunotherapy (VIT). RAST titers decreased similarly in the VIT and untreated groups. There were 55 testings resulting in 40 recurrent large local reactions occurring in equal incidence in treated and untreated patients. One systemic reaction occurred in an untreated patient. In reviewing 118 patients with sting anaphylaxis, a previous large local reaction occurred in five. These results suggest that after repeat stings, patients with large local reactions tend to have subsequent large local reactions, regardless of the presence of venom-specific IgE or immunotherapy. There is small risk of anaphylaxis. Determination of serum venom-specific IgE by RAST or skin tests does not aid in treatment or in predicting prognosis. Thus skin tests are not necessary in patients who have had large local reactions, and venom immunotherapy is not indicated.

PMID 6491095  J Allergy Clin Immunol. 1984 Oct;74(4 Pt 1):494-8.
著者: D B Golden, D G Marsh, A Kagey-Sobotka, L Freidhoff, M Szklo, M D Valentine, L M Lichtenstein
雑誌名: JAMA. 1989 Jul 14;262(2):240-4.
Abstract/Text The prevalence of insect sting reaction and of venom sensitization in adults is unknown. We report the results of intake evaluation of a stratified random sample of a large adult population previously studied for the determinants of atopic disease. In 269 subjects, the prevalence of systemic allergic sting reactions was 3.3% and 26.5% had IgE antibodies to venom demonstrated by skin test or radioallergosorbent test. Asymptomatic sensitization (positive venom skin test) was observed in 15% of subjects with no history of an allergic sting reaction. Positive venom skin tests were more frequent in men, in those with positive skin tests to inhalant allergens, and in subjects aged 20 through 29 years. A positive venom skin test or radioallergosorbent test was more frequent in subjects who had been stung within the previous 3 years (35%) than in those stung more than 3 years before (20%). We conclude that both systemic allergic reactions to insect stings and asymptomatic sensitivity to venom are common and that most affected persons never seek medical advice. The significance of asymptomatic venom sensitization is unknown.

PMID 2739018  JAMA. 1989 Jul 14;262(2):240-4.
著者: D Charpin, J Birnbaum, D Vervloet
雑誌名: Clin Exp Allergy. 1994 Nov;24(11):1010-5.
Abstract/Text
PMID 7874599  Clin Exp Allergy. 1994 Nov;24(11):1010-5.
著者: K J Hunt, M D Valentine, A K Sobotka, A W Benton, F J Amodio, L M Lichtenstein
雑誌名: N Engl J Med. 1978 Jul 27;299(4):157-61. doi: 10.1056/NEJM197807272990401.
Abstract/Text Insect hypersensitivity is currently treated by immunization using whole-body extracts. We compared this regimen with immunotherapy using insect venoms or placebo in groups of 20 patients matched for history and sensitivity, as judged by venom skin test, histamine release and IgE antibody to venom. After six to 10 weeks of immunization, systemic reactions to stings occurred in seven of 12, seven of 11, and one of 18 patients treated with placebo, whole-body extract, and venom, respectively. Placebo and whole-body extract gave similar results and were significantly less effective than venom immunotherapy (P less than 0.01). The 14 patients with failure of treatment with whole-body extract and placebo were subsequently provided with venom immunotherapy; one reacted to a subsequent sting. We conclude that venom immunotherapy is clinically superior to therapy on whole-body extract or placebo.

PMID 78446  N Engl J Med. 1978 Jul 27;299(4):157-61. doi: 10.1056/N・・・
著者: P L Smith, A Kagey-Sobotka, E R Bleecker, R Traystman, A P Kaplan, H Gralnick, M D Valentine, S Permutt, L M Lichtenstein
雑誌名: J Clin Invest. 1980 Nov;66(5):1072-80. doi: 10.1172/JCI109936.
Abstract/Text In the course of a controlled study to evaluate different forms of immunotherapy for subjects with insect-sting hypersensitivity, we observed 11 subjects who had systemic cutaneous urticarial reactions and 3 subjects who experienced systemic anaphylaxis. With the exception of tachycardia, there were no cardiopulmonary changes in the subjects with urticaria, whereas the major manifestation of anaphylactic shock in the other three subjects was severe hypotension that was probably secondary to peripheral vasodilation. Significant abnormalities in gas exchange developed in two subjects. In one, bronchospasm precipitated a respiratory arrest followed by endotracheal intubation with mechanical ventilation. Although plasma histamine levels were not related to the development of cutaneous reactions, the plasma histamine levels correlated with the severity and duration of the cardiopulmonary changes observed during anaphylactic shock. The two subjects with the most severe shock showed evidence of intravascular coagulation characterized by a diminution of Factor V, Factor VIII, fibrinogen, and high molecular weight kininogen, as well as changes in components of the complement system. Standard therapy with epinephrine and fluids, usually recommended for the treatment of systemic anaphylaxis, did not immediately reverse either the hemodynamic or the respiratory abnormalities in the two subjects with the most severe anaphylactic shock. Hemodynamic recovery was gradual and did not seem directly related to any specific therapeutic intervention.

PMID 6776143  J Clin Invest. 1980 Nov;66(5):1072-80. doi: 10.1172/JCI・・・
著者: Mimi L K Tang, Nicholas Osborne, Katrina Allen
雑誌名: Curr Opin Allergy Clin Immunol. 2009 Aug;9(4):351-6. doi: 10.1097/ACI.0b013e32832db95a.
Abstract/Text PURPOSE OF REVIEW: The prevalence of allergic disorders has more than doubled in the last two decades leading to increased community concern and anxiety, and unprecedented demand for allergy-specialist services. However, although allergic reactions are common, anaphylaxis is uncommon and fatal anaphylaxis is rare. This review examines recent developments in the epidemiology of anaphylaxis, focusing on new information that may assist in identifying those at increased risk of severe reactions and adverse outcomes.
RECENT FINDINGS: Recent studies suggest an increase in prevalence of anaphylaxis in industrialized countries. Examination of the demographic characteristics of anaphylaxis has revealed potential approaches to better recognize those at greatest risk. Novel laboratory approaches to identify patients at increased risk of severe reactions have been suggested.
SUMMARY: Increased knowledge of the epidemiology of anaphylaxis has provided insights into the characteristics of those patient groups most at risk of adverse outcomes. However, these characteristics have poor specificity and limited applicability for detection of at-risk individuals in the clinical setting. Further research is required to facilitate more accurate assessment of an individual's risk for anaphylaxis or fatal outcome. This would represent a major advance in clinical management and enable better allocation of existing healthcare resources.

PMID 19506470  Curr Opin Allergy Clin Immunol. 2009 Aug;9(4):351-6. do・・・
著者: Theodore M Freeman
雑誌名: N Engl J Med. 2004 Nov 4;351(19):1978-84. doi: 10.1056/NEJMcp042013.
Abstract/Text
PMID 15525723  N Engl J Med. 2004 Nov 4;351(19):1978-84. doi: 10.1056/・・・
著者: P K Visscher, R S Vetter, S Camazine
雑誌名: Lancet. 1996 Aug 3;348(9023):301-2.
Abstract/Text BACKGROUND: Conventional advice on immediate treatment of honey-bee stings has emphasised that the sting should be scraped off, never pinched. The morphology of the sting suggested little basis for this advice, which is likely to slow down removal of the sting.
METHODS: The response to honey-bee stings was assayed with a measurement of the size of the resulting weal. Injection of known quantities of venom showed that this measurement is a good indicator of envenomisation.
FINDINGS: Weal size, and thus envenomisation, increased as the time from stinging to removal of the sting increased, even within a few seconds. There was no difference in response between stings scraped or pinched off after 2 s.
INTERPRETATION: These data suggest that advice to patients on the immediate treatment of bee stings should emphasise quick removal, without concern for the method of removal.

PMID 8709689  Lancet. 1996 Aug 3;348(9023):301-2.
著者: Vandana Jain, Debraj Shome, Sundaram Natarajan
雑誌名: Cornea. 2007 Dec;26(10):1277-8. doi: 10.1097/ICO.0b013e31814b8bae.
Abstract/Text PURPOSE: To report a case of chronic keratouveitis caused by a missed bee sting injury.
METHODS: A 17-year-old boy was referred for management of unresponsive viral keratouveitis. Ocular examination revealed corneal edema and scarring, atrophic patches on the iris, and anterior polar cataracts. Surprisingly, examination also revealed a retained intracorneal bee stinger. A retrospective inquiry confirmed a bee sting injury 2 years ago.
RESULTS: The patient was started on medical treatment and underwent operative removal of the bee stinger. Postsurgery, visual acuity improved, and the corneal edema regressed over a 1-month follow-up.
CONCLUSIONS: In cases of chronic keratouveitis, a meticulous examination is mandatory to rule out unusual causes like a retained corneal bee stinger. A retained intracorneal bee stinger may result in long-term corneal inflammation, which may not be controlled adequately with topical steroids. It should be removed, irrespective of the duration since the injury.

PMID 18043193  Cornea. 2007 Dec;26(10):1277-8. doi: 10.1097/ICO.0b013e・・・
著者: W Hur, S K Ahn, S H Lee, W H Kang
雑誌名: J Dermatol. 1991 Dec;18(12):736-9.
Abstract/Text The clinical features and histopathologic findings of a 54-year-old Korean male who had retained the sting apparatus of a bee for four months are described. The clinical features showed ulcerative, erythematous plaques with irregular borders which resembled cutaneous neoplasms such as squamous cell carcinoma. Histopathologic findings included epidermal necrosis and marked pseudoepitheliomatous hyperplasia. In the dermis, the stick-shaped sting apparatus of the bee was demonstrated and intense lymphohistiocytic and eosinophilic infiltrations were noted.

PMID 1806605  J Dermatol. 1991 Dec;18(12):736-9.
著者: John W Tole, Phil Lieberman
雑誌名: Immunol Allergy Clin North Am. 2007 May;27(2):309-26, viii. doi: 10.1016/j.iac.2007.03.011.
Abstract/Text Biphasic anaphylactic reactions have been found to develop in as many as 20% of anaphylactic reactions. The biphasic reaction can be less severe, equally severe, or more severe than the initial reaction, ranging in degree from mild symptoms to fatal reactions. In this review, retrospective and prospective studies as well as case studies and case series are discussed in an attempt to gain insight on the incidence of biphasic reactions, the potential clinical characteristics suggestive of a uniphasic reaction developing into a biphasic reaction, and the recommendations for observation periods after an anaphylactic reaction.

PMID 17493505  Immunol Allergy Clin North Am. 2007 May;27(2):309-26, v・・・
著者: Irene Mittermann, Mihaela Zidarn, Mira Silar, Zora Markovic-Housley, Werner Aberer, Peter Korosec, Mitja Kosnik, Rudolf Valenta
雑誌名: J Allergy Clin Immunol. 2010 Jun;125(6):1300-1307.e3. doi: 10.1016/j.jaci.2010.03.017. Epub 2010 May 13.
Abstract/Text BACKGROUND: The identification of the disease-causing insect in venom allergy is often difficult.
OBJECTIVE: To establish recombinant allergen-based IgE tests to diagnose bee and yellow jacket wasp allergy.
METHODS: Sera from patients with bee and/or wasp allergy (n = 43) and patients with pollen allergy with false-positive IgE serology to venom extracts were tested for IgE reactivity in allergen extract-based tests or with purified allergens, including nonglycosylated Escherichia coli-expressed recombinant (r) Api m 1, rApi m 2, rVes v 5, and insect cell-expressed, glycosylated rApi m 2 as well as 2 natural plant glycoproteins (Phl p 4, bromelain).
RESULTS: The patients with venom allergy could be diagnosed with a combination of E coli-expressed rApi m 1, rApi m 2, and rVes v 5 whereas patients with pollen allergy remained negative. For a group of 29 patients for whom the sensitizing venom could not be identified with natural allergen extracts, testing with nonglycosylated allergens allowed identification of the sensitizing venom. Recombinant nonglycosylated allergens also allowed definition of the sensitizing venom for those 14 patients who had reacted either with bee or wasp venom extracts. By IgE inhibition studies, it is shown that glycosylated Api m 2 contains carbohydrate epitopes that cross-react with natural Api m 1, Ves v 2, natural Phl p 4, and bromelain, thus identifying cross-reactive structures responsible for serologic false-positive test results or double-positivity to bee and wasp extracts.
CONCLUSION: Nonglycosylated recombinant bee and wasp venom allergens allow the identification of patients with bee and wasp allergy and should facilitate accurate prescription of venom immunotherapy.

Copyright (c) 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
PMID 20466415  J Allergy Clin Immunol. 2010 Jun;125(6):1300-1307.e3. d・・・
著者: M Niedoszytko, J de Monchy, J J van Doormaal, E Jassem, J N G Oude Elberink
雑誌名: Allergy. 2009 Sep;64(9):1237-45. doi: 10.1111/j.1398-9995.2009.02118.x. Epub 2009 Jul 21.
Abstract/Text The most important causative factor for anaphylaxis in mastocytosis are insect stings. The purpose of this review is to analyse the available data concerning prevalence, diagnosis, safety and effectiveness of venom immunotherapy (VIT) in mastocytosis patients. If data were unclear, authors were contacted personally for further information. Quality of evidence (A: high, B: moderate, C: low and D: very low) and strength of recommendation (strong 1 and weak 2) concerning VIT in mastocytosis patients are assessed according to the Grading of Recommendations Assessment, Development and Evaluation and are marked in square brackets. Results of VIT were described in 117 patients to date. The mean rate of side-effects during treatment in studies published so far is 23.9% (7.6% requiring adrenaline) with an overall protection rate of 72%. Based on the review we conclude that (1) mastocytosis patients have a high risk of severe sting reactions in particular to yellow jacket, (2) VIT could be suggested [2] in mastocytosis, (3) probably should be done life long [2], (4) VIT in mastocytosis is accompanied by a higher frequency of side-effects, so (5) special precautions should be taken into account notably during the built up phase of the therapy [2], (6) VIT is able to reduce systemic reactions, but to a lesser extent compared to the general insect venom allergic population [2], so (7) patients should be warned that the efficacy of VIT might be less than optimal and they should continue carrying two adrenaline auto injectors [2].

PMID 19627278  Allergy. 2009 Sep;64(9):1237-45. doi: 10.1111/j.1398-99・・・
著者: B M Biló, F Rueff, H Mosbech, F Bonifazi, J N G Oude-Elberink, EAACI Interest Group on Insect Venom Hypersensitivity
雑誌名: Allergy. 2005 Nov;60(11):1339-49. doi: 10.1111/j.1398-9995.2005.00963.x.
Abstract/Text The purpose of diagnostic procedure is to classify a sting reaction by history, identify the underlying pathogenetic mechanism, and identify the offending insect. Diagnosis of Hymenoptera venom allergy thus forms the basis for the treatment. In the central and northern Europe vespid (mainly Vespula spp.) and honeybee stings are the most prevalent, whereas in the Mediterranean area stings from Polistes and Vespula are more frequent than honeybee stings; bumblebee stings are rare throughout Europe and more of an occupational hazard. Several major allergens, usually glycoproteins with a molecular weight of 10-50 kDa, have been identified in venoms of bees, vespids. and ants. The sequences and structures of the majority of venom allergens have been determined and several have been expressed in recombinant form. A particular problem in the field of cross-reactivity are specific immunoglobulin E (IgE) antibodies directed against carbohydrate epitopes, which may induce multiple positive test results (skin test, in vitro tests) of still unknown clinical significance. Venom hypersensitivity may be mediated by immunologic mechanisms (IgE-mediated or non-IgE-mediated venom allergy) but also by nonimmunologic mechanisms. Reactions to Hymenoptera stings are classified into normal local reactions, large local reactions, systemic toxic reactions, systemic anaphylactic reactions, and unusual reactions. For most venom-allergic patients an anaphylactic reaction after a sting is very traumatic event, resulting in an altered health-related quality of life. Risk factors influencing the outcome of an anaphylactic reaction include the time interval between stings, the number of stings, the severity of the preceding reaction, age, cardiovascular diseases and drug intake, insect type, elevated serum tryptase, and mastocytosis. Diagnostic tests should be carried out in all patients with a history of a systemic sting reaction to detect sensitization. They are not recommended in subjects with a history of large local reaction or no history of a systemic reaction. Testing comprises skin tests with Hymenoptera venoms and analysis of the serum for Hymenoptera venom-specific IgE. Stepwise skin testing with incremental venom concentrations is recommended. If diagnostic tests are negative they should be repeated several weeks later. Serum tryptase should be analyzed in patients with a history of a severe sting reaction.

PMID 16197464  Allergy. 2005 Nov;60(11):1339-49. doi: 10.1111/j.1398-9・・・
著者: David B K Golden, John Moffitt, Richard A Nicklas, Theodore Freeman, David F Graft, Robert E Reisman, James M Tracy, David Bernstein, Joann Blessing-Moore, Linda Cox, David A Khan, David M Lang, John Oppenheimer, Jay M Portnoy, Christopher Randolph, Diane E Schuller, Sheldon L Spector, Steven A Tilles, Dana Wallace, Joint Task Force on Practice Parameters, American Academy of Allergy, Asthma & Immunology (AAAAI), American College of Allergy, Asthma & Immunology (ACAAI), Joint Council of Allergy, Asthma and Immunology
雑誌名: J Allergy Clin Immunol. 2011 Apr;127(4):852-4.e1-23. doi: 10.1016/j.jaci.2011.01.025.
Abstract/Text These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Stinging insect hypersensitivity: a practice parameter update II." Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or the ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. These parameters are not designed for use by pharmaceutical companies in drug promotion. The Joint Task Force understands that the cost of diagnostic tests and therapeutic agents is an important concern that may appropriately influence the work-up and treatment chosen for a given patient. The Joint Task Force recognizes that the emphasis of our primary recommendations regarding a medication may vary, for example, depending on third party payer issues and product patent expiration dates. However, since a given test or agent's cost is so widely variable, and there is a paucity of pharmacoeconomic data, the Joint Task Force generally does not consider cost when formulating Practice Parameter recommendations. In extraordinary circumstances, when the cost benefit of an intervention is prohibitive as supported by pharmacoeconomic data, commentary may be provided.

Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
PMID 21458655  J Allergy Clin Immunol. 2011 Apr;127(4):852-4.e1-23. do・・・
著者: J W Georgitis, R E Reisman
雑誌名: J Allergy Clin Immunol. 1985 Dec;76(6):803-7.
Abstract/Text Intradermal skin tests with varying concentrations of honeybee, yellow jacket, white-faced hornet, yellow hornet, and Polistes venoms were done on 85 patients with histories of insect-sting anaphylaxis and on 56 insect-nonallergic subjects. Positive skin tests (wheal greater than or equal to 5 to 10 mm and flare greater than or equal to 11 to 20 mm) were present in 67 insect-allergic patients at venom concentrations ranging from 0.001 microgram/ml to 0.1 microgram/ml. Seven additional allergic patients had positive skin tests with the 1.0 microgram/ml venom concentration. Twenty-six nonallergic subjects had positive skin tests at the venom concentration of 1.0 microgram/ml, and two patients had positive skin tests at the lower venom concentrations (0.001 to 0.1 microgram/ml). These results confirm venom skin tests as a highly sensitive method of detecting venom-specific IgE in the evaluation of patients with stinging-insect hypersensitivity. Since a large percentage of insect-nonallergic subjects reacted to the 1.0 microgram/ml concentration, clinical judgment and further in vitro testing should be considered in the evaluation of patients who react only at this venom concentration.

PMID 3877747  J Allergy Clin Immunol. 1985 Dec;76(6):803-7.
著者: Beatrice M Bilò, Floriano Bonifazi
雑誌名: Curr Opin Allergy Clin Immunol. 2008 Aug;8(4):330-7. doi: 10.1097/ACI.0b013e32830638c5.
Abstract/Text PURPOSE OF REVIEW: Knowledge of the epidemiology, natural history and risk factors of insect-venom allergy is crucial for improving the clinical management of allergic patients. This review focuses on the recent research on these aspects of Hymenoptera-sting anaphylactic reactions.
RECENT FINDINGS: The latest data from population-based studies of anaphylactic reactions due to Hymenoptera stings, as well as those extrapolated from studies of epidemiology of anaphylaxis due to any cause are reviewed. The topic of biphasic anaphylactic reactions due to insect stings is also examined. Although no parameter has been identified that can predict which sensitized individuals will have a future anaphylactic reaction, several factors associated with the severity of a systemic resting reaction are known and emphasized here.
SUMMARY: As half of individuals with fatal sting reactions had no documented history of previous systemic reaction, we need to further improve the knowledge of the natural history and risk factors, especially in asymptomatic-sensitized individuals. Moreover, and no less important, the epidemiological studies on sting anaphylaxis conducted in the 2000s continue to reveal the poor management of allergic patients and the startling lack of awareness of the efficacy of venom immunotherapy. These findings indicate the urgent need to educate the general population and doctors on the management of venom-allergic patients.

PMID 18596590  Curr Opin Allergy Clin Immunol. 2008 Aug;8(4):330-7. do・・・
著者: H H Franken, A E Dubois, H J Minkema, S van der Heide, J G de Monchy
雑誌名: J Allergy Clin Immunol. 1994 Feb;93(2):431-6.
Abstract/Text To investigate the reproducibility of a single negative response to sting challenge with a living insect, we rechallenged a group of 61 patients who showed no clinical response to a first sting challenge. All patients had previously had symptoms suggestive of anaphylaxis after a yellow jacket field sting. Thirteen patients (21%) had anaphylactic responses after the second sting challenge, and six of these patients had severe reactions including symptomatic hypotension requiring administration of Adrenalin. This rate was significantly lower than the response rate of the original patient group to a first sting challenge (39%). Thus although fewer positive responses were observed in patients who had had a previous negative challenge response, the number of anaphylactic reactions was considerable and included patients with potentially life-threatening symptoms. Consequently, a single sting challenge may not be used to select patients for venom immunotherapy.

PMID 8120270  J Allergy Clin Immunol. 1994 Feb;93(2):431-6.
著者: David B K Golden, Denise Kelly, Robert G Hamilton, Timothy J Craig
雑誌名: J Allergy Clin Immunol. 2009 Jun;123(6):1371-5. doi: 10.1016/j.jaci.2009.03.017. Epub 2009 May 13.
Abstract/Text BACKGROUND: Large local reactions to insect stings cause significant morbidity and impair quality of life. Venom immunotherapy is not recommended because of a low risk for future systemic reaction and unproven efficacy in preventing large local reactions.
OBJECTIVE: To determine the feasibility of performing a controlled trial to examine the efficacy of venom immunotherapy in reducing the size and duration of large local reactions.
METHODS: Sting challenge in 41 patients with previous large local reactions and positive venom skin tests caused large local reactions 16 cm or larger in 34 patients, and 29 consented to treatment. Venom immunotherapy was initiated in 19, and 10 were untreated controls. Sting challenge was repeated after 7 to 11 weeks (control patients then began venom immunotherapy), and annually for as long as 4 years.
RESULTS: After 7 to 11 weeks of treatment, the size and duration of large local reactions decreased 42% and 53%, respectively, in treated patients and 18% in controls (P < .01 for both). The response was similar after 1 year, and improved after 2 to 4 years to 60% and 70%, respectively.
CONCLUSIONS: Venom immunotherapy significantly reduced the size and duration of the large local reactions, and the efficacy improved over a period of 2 to 4 years of treatment. Further studies are needed to establish the safety and efficacy of venom immunotherapy for large local reactions, the optimal duration of treatment, and the mechanism for the differences in degree and rate of clinical response compared with venom immunotherapy in systemic reactors.

PMID 19443022  J Allergy Clin Immunol. 2009 Jun;123(6):1371-5. doi: 10・・・
著者: David B K Golden, Anne Kagey-Sobotka, Philip S Norman, Robert G Hamilton, Lawrence M Lichtenstein
雑誌名: N Engl J Med. 2004 Aug 12;351(7):668-74. doi: 10.1056/NEJMoa022952.
Abstract/Text BACKGROUND: Children are thought to "outgrow" the allergy to insect stings, but there are no reports documenting the natural history of this reaction. We studied the outcome of allergic reactions to insect stings in childhood 10 to 20 years afterward in patients who had not received venom immunotherapy and in those who had been treated.
METHODS: Between 1978 and 1985, we diagnosed allergic reaction to insect stings in 1033 children, of whom 356 received venom immunotherapy. We conducted a survey of these patients by telephone and mail between January 1997 and January 2000, to determine the outcome of stings that occurred in the period from 1987 through 1999.
RESULTS: Of the 1033 patients, 512 patients (50 percent) responded, with a mean follow-up period of 18 years, a mean duration of venom immunotherapy of 3.5 years in treated patients, and an incidence of stings of 43 percent. Systemic reactions occurred less frequently in patients who had received venom immunotherapy (2 of 64 patients, or 3 percent) than in untreated patients (19 of 111 patients, or 17 percent; P=0.007). Patients with a history of moderate-to-severe reactions had a higher rate of reaction if they had not been treated (7 of 22 patients, or 32 percent) than if they had received venom immunotherapy (2 of 43 patients, or 5 percent; P=0.007). In patients who had been treated and who had a history of mild (cutaneous) systemic reaction (i.e., one with only cutaneous manifestations), none of the 21 subjects who received stings had a systemic reaction.
CONCLUSIONS: A clinically important number of children do not outgrow allergic reactions to insect stings. Venom immunotherapy in children leads to a significantly lower risk of systemic reaction to stings even 10 to 20 years after treatment is stopped, and this prolonged benefit is greater than the benefit seen in adults.

Copyright 2004 Massachusetts Medical Society
PMID 15306668  N Engl J Med. 2004 Aug 12;351(7):668-74. doi: 10.1056/N・・・
著者: M D Valentine, K C Schuberth, A Kagey-Sobotka, D F Graft, K A Kwiterovich, M Szklo, L M Lichtenstein
雑誌名: N Engl J Med. 1990 Dec 6;323(23):1601-3. doi: 10.1056/NEJM199012063232305.
Abstract/Text BACKGROUND: The treatment of patients allergic to insect stings with insect-venom injections has been shown to be 97 percent effective in reducing the risk of sting-induced anaphylaxis. However, the frequency of systemic reactions to subsequent stings in unimmunized adults with previous reactions is approximately 60 percent. To determine which factors, in addition to a history of reaction and evidence of venom-specific IgE antibody, predispose patients to future insect-sting reactions, we studied a venom-sensitive group of children who were deemed to be at relatively low risk for severe reactions; 28 percent of them received venom therapy.
METHODS: We studied 242 children, 2 through 16 years of age, each of whom had had a systemic allergic reaction, affecting only the skin, to an insect sting. Each child had a positive skin-test reaction to one or more of five hymenopteran venoms. Sixty-eight children received immunotherapy with insect venom and 174 did not; about half were randomly assigned to treatment groups, and the rest were assigned on the basis of the patient's (or the parents') choice. The results of accidental stings during four years of observation were evaluated.
RESULTS: In the treated group, 84 stings in 36 patients resulted in one systemic reaction (1.2 percent of stings). In contrast, 196 stings in 86 untreated children resulted in 18 systemic reactions (9.2 percent of stings, P less than 0.001). Sixteen of these 18 reactions were judged to be milder than the patient's reaction to the first sting, 2 were similar in severity, and none were more severe.
CONCLUSIONS: These data confirm that immunotherapy with insect venom prevents recurrences of systemic reactions after subsequent insect stings. Because of the surprisingly low rate of reactions among untreated children, we could not identify any characteristics that were predictive of repeat reactions. Since only 9.2 percent of stings in the untreated children led to a systemic reaction and since there was no progression to a more severe reaction, we conclude that venom immunotherapy is unnecessary for most children who are allergic to insect stings.

PMID 2098016  N Engl J Med. 1990 Dec 6;323(23):1601-3. doi: 10.1056/N・・・
著者: David P Betten, William H Richardson, Tri C Tong, Richard F Clark
雑誌名: Pediatrics. 2006 Jan;117(1):231-5. doi: 10.1542/peds.2005-1075.
Abstract/Text Massive envenomations by honey bees are capable of causing multiorgan dysfunction as a result of the direct toxic effects of the large venom load received. Although all varieties of honey bee have the potential for these attacks, the Africanized honey bee (Apis mellifera scutellata) is the most commonly implicated subspecies. In the United States, the Africanized strain is found primarily in the southwestern states and is known for its highly defensive behavior if disturbed. Mechanisms behind the multiorgan dysfunction produced by these mass envenomations are not clearly understood. We present a case of a 13-year-old male who was stung by approximately 700 honey bees and developed progressive upper-body swelling and systemic manifestations of mass envenomation including rhabdomyolysis, renal insufficiency, and a transient transaminase elevation.

PMID 16396886  Pediatrics. 2006 Jan;117(1):231-5. doi: 10.1542/peds.20・・・
著者: R S Vetter, P K Visscher, S Camazine
雑誌名: West J Med. 1999 Apr;170(4):223-7.
Abstract/Text Stinging events involving honey bees and wasps are rare; most deaths or clinically important incidents involve very few stings (< 10) and anaphylactic shock. However, mass stinging events can prove life-threatening via the toxic action of the venom when injected in large amounts. With the advent of the Africanized honey bee in the southwestern United States and its potential for further spread, mass envenomation incidents will increase. Here we review the literature on mass stinging events involving honey bees and wasps (i.e., yellowjackets, wasps, and hornets). Despite different venom composition in the two insect groups, both may cause systemic damage and involve hemolysis, rhabdomyolysis, and acute renal failure. Victim death may occur due to renal failure or cardiac complications. With supportive care, however, most victims should be able to survive attacks from hundreds of wasps or approximately 1000 honey bees.

PMID 10344177  West J Med. 1999 Apr;170(4):223-7.
著者: Karen J Riches, David Gillis, Ross A James
雑誌名: Pathology. 2002 Jun;34(3):257-62. doi: 10.1080/00313020220131327.
Abstract/Text Although severe reactions to the sting of the common honey bee (Apis mellifera) are a common problem in Australia, reported deaths are uncommon, with the estimated mortality varying from one to four persons each year. The following study presents the postmortem findings in three cases of bee sting fatality, including one in which no observable sting was found. An autopsy approach to such cases is detailed. Overreporting of bee sting-related deaths may occur due to the inclusion of deaths unrelated to a reaction to bee venom, while under-reporting may be due to unexplained deaths where a history of a bee sting is not available or apparent at autopsy. A classification of bee sting-related deaths is proposed, which would allow more accurate reporting of bee sting-related fatalies. A serum tryptase and specific IgE to bee venom on serum obtained at autopsy can assist in confirming anaphylactic reaction to bee venom as the cause of death, particularly in the absence of observable stings. Although there are limitations to the usefulness of serum tryptase tests in the postmortem situation, it may still be useful to confirm suspected anaphylaxis in autopsy cases with an undetermined cause of death.

PMID 12109787  Pathology. 2002 Jun;34(3):257-62. doi: 10.1080/00313020・・・
著者: P Huber, P Schmid, R Hoigné, U Müller
雑誌名: Schweiz Med Wochenschr. 1983 Dec 10;113(49):1863-5.
Abstract/Text 458 patients with systemic allergic reactions following hymenoptera stings were investigated with regard to the incidence of atopic disease. Personal atopy (13.7%) and a family history of atopy (26.4%) were not found more frequently than in a normal population. The age of the first manifestation of hymenoptera sting allergy was however significantly lower in atopic than in non-atopic patients, sensitization occurred following a smaller number of stings and there was a preponderance of respiratory symptoms.

PMID 6676939  Schweiz Med Wochenschr. 1983 Dec 10;113(49):1863-5.
著者: R S Pumphrey
雑誌名: Clin Exp Allergy. 2000 Aug;30(8):1144-50.
Abstract/Text BACKGROUND: The unpredictability of anaphylactic reactions and the need for immediate, often improvised treatment will make controlled trials impracticable; other means must therefore be used to determine optimal management.
OBJECTIVES: This study aimed to investigate the circumstances leading to fatal anaphylaxis.
METHODS: A register was established including all fatal anaphylactic reactions in the UK since 1992 that could be traced from the certified cause of death. Data obtained from other sources suggested that deaths certified as due to anaphylaxis underestimate the true incidence. Details of the previous medical history, the reaction and necropsy were sought for all cases.
RESULTS: Approximately half the 20 fatal reactions recorded each year in the UK were iatrogenic, and a quarter each due to food or insect venom. All fatal reactions thought to have been due to food caused difficulty breathing that in 86% led to respiratory arrest; shock was more common in iatrogenic and venom reactions. The median time to respiratory or cardiac arrest was 30 min for foods, 15 min for venom and 5 min for iatrogenic reactions. Twenty-eight per cent of fatal cases were resuscitated but died 3 h-30 days later, mostly from hypoxic brain damage. Adrenaline (epinephrine) was used in treatment of 62% of fatal reactions but before arrest in only 14%.
CONCLUSIONS: Immediate recognition of anaphylaxis, early use of adrenaline, inhaled beta agonists and other measures are crucial for successful treatment. Nevertheless, a few reactions will be fatal whatever treatment is given; optimal management of anaphylaxis is therefore avoidance of the cause whenever this is possible. Predictable cross-reactivity between the cause of the fatal reaction and that of previous reactions had been overlooked. Adrenaline overdose caused at least three deaths and must be avoided. Kit for self-treatment had proved unhelpful for a variety of reasons; its success depends on selection of appropriate medication, ease of use and good training.

PMID 10931122  Clin Exp Allergy. 2000 Aug;30(8):1144-50.
著者: K J L Choo, E Simons, Aziz Sheikh
雑誌名: Allergy. 2010 Oct;65(10):1205-11. doi: 10.1111/j.1398-9995.2010.02424.x. Epub 2010 Jun 18.
Abstract/Text BACKGROUND: Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may result in death. A number of guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis.
OBJECTIVES: We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis.
METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), MEDLINE (Ovid) (1966 to September 2009), EMBASE (Ovid) (1988 to September 2009), CINAHL (EBSCOhost) (to September 2009) and The Science Citation Index Expanded (SCI-EXPANDED) (1945 to September 2009). We also searched the UK National Research Register and websites listing ongoing trials and contacted international experts in anaphylaxis in an attempt to locate unpublished material. We sought to include randomized and quasi-randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline (epinephrine), an antihistamine, or any combination of these). Two authors independently assessed articles for inclusion.
RESULTS: None of the 2496 reports identified satisfied the inclusion criteria.
CONCLUSIONS: We conclude that there is no evidence from high-quality studies for the use of steroids in the emergency management of anaphylaxis. Therefore, we can neither support nor refute the use of these drugs for this purpose.

PMID 20584003  Allergy. 2010 Oct;65(10):1205-11. doi: 10.1111/j.1398-9・・・
著者: A Sheikh, V Ten Broek, S G A Brown, F E R Simons
雑誌名: Allergy. 2007 Aug;62(8):830-7. doi: 10.1111/j.1398-9995.2007.01435.x.
Abstract/Text BACKGROUND: Anaphylaxis is an acute systemic allergic reaction, which can be life-threatening. H(1)-antihistamines are commonly used as an adjuvant therapy in the treatment of anaphylaxis. We sought to assess the benefits and harm of H(1)-antihistamines in the treatment of anaphylaxis.
METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library); MEDLINE (1966 to June 2006); EMBASE (1966 to June 2006); CINAHL (1982 to June 2006) and ISI Web of Science (1945 to July 2006). We also contacted pharmaceutical companies and international experts in anaphylaxis in an attempt to locate unpublished material. Randomized and quasi-randomized-controlled trials comparing H(1)-antihistamines with placebo or no intervention were eligible for inclusion. Two authors independently assessed articles for inclusion.
RESULTS: We found no studies that satisfied the inclusion criteria.
CONCLUSIONS: Based on this review, we are unable to make any recommendations for clinical practice. Randomized-controlled trials are needed, although these are likely to prove challenging to design and execute.

PMID 17620060  Allergy. 2007 Aug;62(8):830-7. doi: 10.1111/j.1398-9995・・・
著者: Robert G Hamilton
雑誌名: Curr Opin Allergy Clin Immunol. 2004 Aug;4(4):297-306.
Abstract/Text PURPOSE OF REVIEW: This review overviews advances from mid-2002 to the present in the validation and performance methods used in the diagnosis of Hymenoptera venom-induced immediate-type hypersensitivity.
RECENT FINDINGS: The general diagnostic algorithm for insect sting allergy is initially discussed with an examination of the AAAAI's 2003 revised practice parameter guidelines. Changes as a result of a greater recognition of skin test negative systemic reactors include repeat analysis of all testing and acceptance of serology as a complementary diagnostic test to the skin test. Original data examining concordance of venom-specific IgE results produced by the second-generation Pharmacia CAP System with the Johns Hopkins University radioallergosorbent test are presented. Diagnostic performance of honeybee venom-specific IgE assays used in clinical laboratories in North America is discussed using data from the Diagnostic Allergy Proficiency Survey conducted by the College of American Pathologists. Validity of venom-specific IgE antibody in postmortem blood specimens is demonstrated. The utility of alternative in-vivo (provocation) and in-vitro (basophil-based) diagnostic testing methods is critiqued.
SUMMARY: This overview supports the following conclusions. Improved practice parameter guidelines include serology and skin test as complementary in supporting a positive clinical history during the diagnostic process. Data are provided which support the analytical performance of commercially available venom-specific IgE antibody serology-based assays. Intentional sting challenge in-vivo provocation, in-vitro basophil flow cytometry (CD63, CD203c) based assays, and in-vitro basophil histamine and sulfidoleukotriene release assays have their utility in the study of difficult diagnostic cases, but their use will remain as supplementary, secondary diagnostic tests.

PMID 15238796  Curr Opin Allergy Clin Immunol. 2004 Aug;4(4):297-306.

ページ上部に戻る

戻る

さらなるご利用にはご登録が必要です。

こちらよりご契約または優待日間無料トライアルお申込みをお願いします。

(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから