IgE. Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death

Transcription

1 Vol.21 No.1, % 1% Vol.21 No.1, 29, 2014 I J-STAGE h-hmituhata@lares.dti.ne.jp IgE 2 Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death II immunologic anaphylaxis non-immunologic anaphylaxis IgE-mediated allergic anaphylaxis

2 non-igeigg-mediated, immune complex complement-mediatedanaphylaxis anaphylactoid reaction 4 III 2 p-aminobenzoic acidpaba T IgE 5 II 6 methylp-hydroxybenzoate PABA PABA OTC 7 IV V VI A3 G D2 C4 - IL-4IL-5IL-6IL-8IL-13 IL

3 Vol.21 No.1, Bezold-Jarisch VII

4 a b 2 2 a b c d 3 a 30 b 90 mmhg VIII 18, Mayo Clinic IX

5 Vol.21 No.1, mlkg 1 30 mlkg gkg g 0.3 mg 0.01 mgkg 8H mg 9H2 50 mg 1 mgkg mgkg gkgmin 1 mg1 ml1 A 100 ml mgkgmin 13ACE mg 2030 gkg 1 mg 515 gmin mgkg120 mg mg X ABC 1,000 ml min CAB H1 26

6 H1 H2 H2 H1 H1 H1 H2 H2 H1 H1 H XI 2 biphasic anaphylaxis XII C1 C3C4C5 IgE XIII 46 in vitro in vivo in vitro IgE cellular allergen stimulation test CASTin vivo mm 0.02 ml 9 mm 20 mm 9 mm ml ml 20

7 Vol.21 No.1, ml ml ml in vivo Thyssen JP, Menne T, Elberling J, et al. Hypersensitivity to local anaesthetics--update and proposal of evaluation algorithm. Contact Dermatitis 2008; 59: Harboe T, Guttormsen AB, Aarebrot S, et al. Suspected allergy to local anaesthetics: follow-up in 135 cases. Acta Anaesthesiol Scand 2010; 54: Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000; 30: Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October J Allergy Clin Immunol 2004; 113: Cuesta-Herranz J, de las Heras M, Fernandez M, et al. Allergic reaction caused by local anesthetic agents belonging to the amide group. J Allergy Clin Immunol 1997; 99: Brown DT, Beamish D, Wildsmith JA. Allergic reaction to an amide local anaesthetic. Br J Anaesth 1981; 53: Kajimoto Y, Rosenberg ME, Kytta J, et al. Anaphylactoid skin reactions after intravenous regional anaesthesia using 0.5 prilocaine with or without preservative--a double-blind study. Acta Anaesthesiol Scand 1995; 39: ,,. R ; 35: Erkkola R, Kanto J, Maenpaa J, et al. Allergic reaction to an amide local anesthetic in segmental epidural analgesia. Acta Obstet Gynecol Scand 1988; 67: Thomas AD, Caunt JA. Anaphylactoid reaction following local anaesthesia for epidural block. Anaesthesia 1993; 48: Allman KG. Anaphylactoid reaction following spinal anaesthesia for caesarean section. Anaesthesia 1993; 48: ,,, ; 59: Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010; 126: e Kounis NG. Kounis syndrome allergic angina and allergic myocardial infarction: a natural paradigm Int J Cardiol 2006; 110: Lieberman P, Camargo CA Jr, Bohlke K, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol 2006; 97: Webb LM, Lieberman P. Anaphylaxis: a review of 601 cases. Ann Allergy Asthma Immunol 2006; 97:

8 17 Greenberger PA. Anaphylactic and anaphylactoid causes of angioedema. Immunol Allergy Clin North Am 2006; 26: Simons FE; World Allergy Organization. World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings. Ann Allergy Asthma Immunol 2011; 104: Simons FE, Ardusso LR, Bilò MB, et al; World Allergy Organization. World Allergy Organization anaphylaxis guidelines: summary. J Allergy Clin Immunol 2011; 127: e Campbell RL, Hagan JB, Manivannan V, et al. Evaluation of national institute of allergy and infectious diseasesfood allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients. J Allergy Clin Immunol 2012; 129: Payne V, Kam PC. Mast cell tryptase: a review of its physiology and clinical significance. Anaesthesia 2004; 59: Mertes PM, Tajima K, Regnier-Kimmoun MA, et al. Perioperative anaphylaxis. Med Clin North Am 2010; 94: , xi. 23 Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122: S Kemp SF, Lockey RF. Anaphylaxis: a review of causes and mechanisms. J Allergy Clin Immunol 2002; 110: Oswalt ML, Kemp SF. Anaphylaxis: office management and prevention. Immunol Allergy Clin North Am 2007; 27: , vi. 26 Winbery SL, Lieberman PL. Histamine and antihistamines in anaphylaxis. Clin Allergy Immunol 2002; 17: Schummer C, Wirsing M, Schummer W. The pivotal role of vasopressin in refractory anaphylactic shock. Anesth Analg 2008; 107: Douglas DM, Sukenick E, Andrade WP, et al. Biphasic systemic anaphylaxis: an inpatient and outpatient study. J Allergy Clin Immunol 1994; 93: Brazil E, MacNamara AF Not so immediatehypersensitivity--the danger of biphasic anaphylactic reactions. J Accid Emerg Med 1998; 15: Fuzier R, Lapeyre-Mestre M, Mertes PM, et al. Immediateand delayed-type allergic reactions to amide local anesthetics: clinical features and skin testing. Pharmacoepidemiol Drug Saf 2009; 18: Sampson HA, Munoz-Furlong A, Bock SA, et al. Symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol 2005; 115: Fisher MM, Bowey CJ. Alleged allergy to local anaesthetics. Anaesth Intensive Care 1997; 25: Glinert RJ, Zachary CB. Local anesthetic allergy. Its recognition and avoidance. J Dermatol Surg Oncol 1991; 17: Chandler MJ, Grammer LC, Patterson R. Provocative challenge with local anesthetics in patients with a prior history of reaction. J Allergy Clin Immunol 1987; 79: Hiromasa MITSUHATA Department of Anesthesiology and Pain Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine Local anesthetics are among the most commonly used drugs in pain clinics. Although an allergic response to a local anesthetic is remarkably rare, local anesthetics are capable of causing true allergic reactions. However, delaying the initiation of treatment may cause death. The mechanism and pathophysiology of anaphylaxes are reviewed, and treatment based on them is discussed. Allergic reactions to local anesthetics are mainly allergic contact dermatitis about 80 ; on the contrary, the frequency of anaphylaxes is around 1. The first-line drugs are oxygen, fluid, and adrenaline. Identification of the causative drug is necessary when anaphylaxis occurs. Clinical course after the initiation of anaphylaxis is so rapid that appropriate treatment should be necessary to prevent severe damage or death. Rapid recognition and treatment of such reactions can prevent much of the morbidity and mortality that would otherwise occur. For these reasons, a pain clinician should be familiar with treatment of anaphylaxes. anaphylaxis, shock, local anesthetics