ハチ刺傷の診断フローチャート

ハチ刺傷では、何よりも先に全身反応を否定する必要がある。
その後、局所反応が単純局所反応かLLRか見極めることで治療の流れが決定する。
出典
img
1: 著者提供

アナフィラキシーの症状

アナフィラキシーでは、全身の臓器にわたり症状が出現する。
出典
imgimg
1: 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.
著者: Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW.
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.
J Allergy Clin Immunol. 2006 Feb;117(2):391-7. doi: 10.1016/j.jaci.200...

LLR（large local reaction）

腫脹・発赤が5～10 cmを超える病変は、LLRとして扱う。
数カ月間にわたり残存することが多い。

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

成人の全身反応例では、次回刺傷時のアナフィラキシーリスクが高く、免疫療法の導入が望ましい。
小児で皮膚にとどまらないアナフィラキシーに至ることは、ハチ刺傷において少ないが、その際は免疫療法が必要になる。
 
参考文献：
Freeman TM. Clinical practice. Hypersensitivity to hymenoptera stings. N Engl J Med. 2004; 351(19): 1978-84.
出典
img
1: 著者提供

アナフィラキシーの診断

循環の虚脱、粘膜に至る障害が認められる場合は、アナフィラキシーと診断する。
出典
imgimg
1: 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.
著者: Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW.
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.
J Allergy Clin Immunol. 2006 Feb;117(2):391-7. doi: 10.1016/j.jaci.200...

色素性蕁麻疹

褐色調の色素斑で瘙痒を伴う。
出典
imgimg
1: Mastocytosis.
Immunol Allergy Clin North Am. 2014 May;34(2):xvii-xviii. doi: 10.1016/j.iac.2014.02.005. Epub 2014 Mar 12.

毒液アレルギーの診断フローチャート

出典
img
1: 著者提供

ハチ刺傷の診断フローチャート

ハチ刺傷では、何よりも先に全身反応を否定する必要がある。
その後、局所反応が単純局所反応かLLRか見極めることで治療の流れが決定する。
出典
img
1: 著者提供

アナフィラキシーの症状

アナフィラキシーでは、全身の臓器にわたり症状が出現する。
出典
imgimg
1: 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.
著者: Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW.
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.
J Allergy Clin Immunol. 2006 Feb;117(2):391-7. doi: 10.1016/j.jaci.200...