UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

儿童及成人全身性过敏反应的鉴别诊断

Author
F Estelle R Simons, MD, FRCPC
Section Editor
Bruce S Bochner, MD
Deputy Editor
Anna M Feldweg, MD
Translators
陈奋华, 副主任医师

引言

全身性过敏反应是一种快速起病且可能致死的严重变态反应。对于在多个身体系统出现特征性症状前几分钟或几小时内明确接触过已知或可能变应原的患者，容易做出诊断。然而，由于全身性过敏反应的症状和体征会与许多其他疾病的症状体征相重叠，所以并非总是能够容易做出诊断[1-3]。

本专题将总结部分症状和体征与儿童和成人全身性过敏反应类似的疾病。婴儿(即2岁以下儿童)及临产和分娩期妊娠女性全身性过敏反应的鉴别诊断见其他专题。全身性过敏反应的快速识别和紧急治疗也参见其他专题。 (参见“婴儿全身性过敏反应”和“妊娠期和哺乳期女性的全身性过敏反应”和“Anaphylaxis: Emergency treatment”)

全身性过敏反应的临床诊断

全身性过敏反应的诊断基于识别特征性症状和体征，这些表现发生在接触潜在触发因素或事件后几分钟到几小时内。这些症状和体征可能包括瘙痒、潮红、荨麻疹、血管性水肿、声音嘶哑、喉头发紧、喘鸣、哮鸣音、咳嗽、呼吸急促、腹痛、呕吐和/或头晕、虚脱或低血压(表 1)。 (参见“Anaphylaxis: Emergency treatment”)

不同患者之间甚至同一患者不同发作之间，身体器官系统的受累情况都不相同。然而，针对全身性过敏反应病例系列及研究队列的评价显示，存在一些一般模式：

●高达90%的发作存在皮肤受累。

                                   

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-07 . | This topic last updated: 2016-06-30.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Sampson HA, Muñoz-Furlong A, Campbell RL, 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.
  2. Simons FE, Ardusso LR, Bilò MB, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J 2011; 4:13.
  3. Lieberman PL. Anaphylaxis. In: Middleton's allergy: Principles and practice, 7th ed, Adkinson NF Jr, Bochner BS, Busse WW, et al (Eds), Mosby, St. Louis 2009. p.1027.
  4. Worm M, Edenharter G, Ruëff F, et al. Symptom profile and risk factors of anaphylaxis in Central Europe. Allergy 2012; 67:691.
  5. Simons FE, Frew AJ, Ansotegui IJ, et al. Risk assessment in anaphylaxis: current and future approaches. J Allergy Clin Immunol 2007; 120:S2.
  6. Sala-Cunill A, Cardona V, Labrador-Horrillo M, et al. Usefulness and limitations of sequential serum tryptase for the diagnosis of anaphylaxis in 102 patients. Int Arch Allergy Immunol 2013; 160:192.
  7. Vickers J, Safai B. Images in clinical medicine. Scombroid poisoning. N Engl J Med 2013; 368:e31.
  8. Bédry R, Gabinski C, Paty MC. Diagnosis of scombroid poisoning by measurement of plasma histamine. N Engl J Med 2000; 342:520.
  9. Palmiere C, Comment L, Vilarino R, et al. Measurement of β-tryptase in postmortem serum in cardiac deaths. J Forensic Leg Med 2014; 23:12.
  10. Zuraw BL. Clinical practice. Hereditary angioedema. N Engl J Med 2008; 359:1027.
  11. Levy JH, Freiberger DJ, Roback J. Hereditary angioedema: current and emerging treatment options. Anesth Analg 2010; 110:1271.
  12. Bork K, Hardt J, Witzke G. Fatal laryngeal attacks and mortality in hereditary angioedema due to C1-INH deficiency. J Allergy Clin Immunol 2012; 130:692.
  13. Triggiani M, Patella V, Staiano RI, et al. Allergy and the cardiovascular system. Clin Exp Immunol 2008; 153 Suppl 1:7.
  14. Triggiani M, Montagni M, Parente R, Ridolo E. Anaphylaxis and cardiovascular diseases: a dangerous liaison. Curr Opin Allergy Clin Immunol 2014; 14:309.
  15. Campbell RL, Hagan JB, Li JT, et al. Anaphylaxis in emergency department patients 50 or 65 years or older. Ann Allergy Asthma Immunol 2011; 106:401.
  16. Noyes BE, Kemp JS. Vocal cord dysfunction in children. Paediatr Respir Rev 2007; 8:155.
  17. Bahrainwala AH, Simon MR. Wheezing and vocal cord dysfunction mimicking asthma. Curr Opin Pulm Med 2001; 7:8.
  18. Izikson L, English JC 3rd, Zirwas MJ. The flushing patient: differential diagnosis, workup, and treatment. J Am Acad Dermatol 2006; 55:193.
  19. Vally H, Thompson PJ. Allergic and asthmatic reactions to alcoholic drinks. Addict Biol 2003; 8:3.
  20. Knight AK, Boxer M, Chandler MJ. Alcohol-induced rash caused by topical tacrolimus. Ann Allergy Asthma Immunol 2005; 95:291.
  21. Lübbe J, Milingou M. Images in clinical medicine. Tacrolimus ointment, alcohol, and facial flushing. N Engl J Med 2004; 351:2740.
  22. Geha RS, Beiser A, Ren C, et al. Multicenter, double-blind, placebo-controlled, multiple-challenge evaluation of reported reactions to monosodium glutamate. J Allergy Clin Immunol 2000; 106:973.
  23. Mooney E. The flushing patient. Int J Dermatol 1985; 24:549.
  24. Kulke MH, Mayer RJ. Carcinoid tumors. N Engl J Med 1999; 340:858.
  25. Becker K, Southwick K, Reardon J, et al. Histamine poisoning associated with eating tuna burgers. JAMA 2001; 285:1327.
  26. Ricci G, Zannoni M, Cigolini D, et al. Tryptase serum level as a possible indicator of scombroid syndrome. Clin Toxicol (Phila) 2010; 48:203.
  27. AAITO-IFIACI Anisakis Consortium. Anisakis hypersensitivity in Italy: prevalence and clinical features: a multicenter study. Allergy 2011; 66:1563.
  28. Rodríguez E, Anadón AM, García-Bodas E, et al. Novel sequences and epitopes of diagnostic value derived from the Anisakis simplex Ani s 7 major allergen. Allergy 2008; 63:219.
  29. Webber CM, England RW. Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge. Ann Allergy Asthma Immunol 2010; 104:101.
  30. Pascal M, Muñoz-Cano R, Reina Z, et al. Lipid transfer protein syndrome: clinical pattern, cofactor effect and profile of molecular sensitization to plant-foods and pollens. Clin Exp Allergy 2012; 42:1529.
  31. Greenberger PA, Lieberman P. Idiopathic anaphylaxis. J Allergy Clin Immunol Pract 2014; 2:243.
  32. Sherenian MG, Clee M, Schondelmeyer AC, et al. Caustic ingestions mimicking anaphylaxis: case studies and literature review. Pediatrics 2015; 135:e547.
  33. Valent P. Mast cell activation syndromes: definition and classification. Allergy 2013; 68:417.
  34. Carter MC, Metcalfe DD, Komarow HD. Mastocytosis. Immunol Allergy Clin North Am 2014; 34:181.
  35. Koike T, Tatewaki W, Aoki A, et al. Brief report: severe symptoms of hyperhistaminemia after the treatment of acute promyelocytic leukemia with tretinoin (all-trans-retinoic acid). N Engl J Med 1992; 327:385.
  36. De Wispelaere L, Vande Velde S, Schelstraete P, et al. Anaphylactic shock as a single presentation of Echinococcus cyst. Acta Gastroenterol Belg 2011; 74:462.
  37. Castanares-Zapatero D, Laterre PF. Ruptured hydatid cyst in a patient with shock. Hepatobiliary Pancreat Dis Int 2009; 8:638.
  38. Murali MR, Uyeda JW, Tingpej B. Case records of the Massachusetts General Hospital. Case 2-2015. A 25-year-old man with abdominal pain, syncope, and hypotension. N Engl J Med 2015; 372:265.
  39. Druey KM, Greipp PR. Narrative review: the systemic capillary leak syndrome. Ann Intern Med 2010; 153:90.
  40. Dowden AM, Rullo OJ, Aziz N, et al. Idiopathic systemic capillary leak syndrome: novel therapy for acute attacks. J Allergy Clin Immunol 2009; 124:1111.
  41. Bahna SL, Oldham JL. Munchausen stridor-a strong false alarm of anaphylaxis. Allergy Asthma Immunol Res 2014; 6:577.