什麼是急性過敏?

2022 年 8 月   Linda Armstrong  |  ✓  醫療審查:Gary Falcetano, PA-C, AE-C;Fabio Iachetti, MD;Rebecca Rosenberger, MMSc, PA-C

Gary Falctano 是一名持照醫師助理,在緊急和災難醫學、基層醫療照護、過敏和免疫學有 25 年以上的豐富經驗,在 Thermo Fisher Scientific 擔任過敏免疫診斷美國臨床事務經理。Fabio Iachetti 是一名持照醫師,在過敏、CV、疼痛、GI、風濕病學、泌尿學、糖尿病學等多種疾病領域擁有 15 年以上的豐富經驗。在 Thermo Fisher Scientific 擔任全球醫療事務過敏免疫診斷資深醫療經理。Rebecca Rosenberger 除了在過敏和免疫學作為一名執業醫師助理擁有 20 年以上的經驗外,也在 Thermo Fisher Scientific 擔任免疫診斷臨床事務 & 教育副主任。

急性過敏一種嚴重且可能危及生命的過敏反應。1和其他過敏症狀一樣,急性過敏的誘發是因為免疫系統對如花生貝類及甲殼類乳膠昆蟲毒液塵蟎等過敏原產生過度反應,並釋放組織胺 (及其他化學物質)。2

組織胺類通常會造成流鼻水、眼睛發癢/流眼淚等症狀。3但有時身體會釋出過量化學物質,使身體產生過敏性休克反應。1血壓可能突然下降,且氣管組織可能會腫脹,並引起喘鳴、呼吸急促和其他症狀,甚至失去意識。若未立即治療,急性過敏可能會導致死亡。3

雖然急性過敏十分罕見,卻是非常嚴重的病症,面對這種病症時可能令人心生畏懼。但透過研究急性過敏的成因、病徵和症狀,並瞭解潛在風險因子管理策略 可能有助於減輕焦慮,讓您和其他人做好準備,以便在急性過敏出現時進行處理。以下是協助您這麼做的入門指南。

急性過敏的病徵和症狀為何?

每個人的急性過敏經驗都是不同的。但還是有幾種常見症狀,大部分都會在接觸過敏原的五至 30 分鐘內出現。然而,在某些情況下,症狀可能在一小時後才出現。3

雖然有些人會立即出現危及生命的反應,有些人可能會出現急性過敏的早期病徵。尤其是有急性過敏病史或高風險的人,請務必辨識早期症狀 (若有) 並立即尋求治療。4

急性過敏的早期病徵

出現急性過敏早期病徵時,其可能包括:3-5

  • 口腔、喉嚨、眼睛和/或臉部發癢
  • 皮膚出現紅色斑塊、蕁麻疹、膨疹
  • 頭皮、手掌和/或足底發癢,可能延伸至耳道、嘴唇和/或外生殖器
  • 鼻塞
  • 喉嚨發緊、嘶啞和/或音調改變
  • 嘴唇和/或舌頭腫脹

對某些人來說,第一個急性過敏病徵最為嚴重,且通常在不只一個身體部位出現,例如皮膚、口腔、肺部、心臟和/或腸道。6

嚴重急性過敏症狀

除了早期的急性過敏病徵外,其他症狀還可能包括:3,5,6

  • 呼吸急促、呼吸困難、咳嗽和/或喘鳴 (即呼吸時發出口哨聲)
  • 暈眩和/或昏厥
  • 肚子絞痛、疼痛、脹氣、嘔吐和/或腹瀉
  • 子宮絞痛
  • 害怕或即將死亡的感覺
  • 胸悶
  • 吞嚥困難
  • 心率增快和/或低血壓
  • 脈搏微弱
  • 意識混亂
  • 突發性無力
  • 暈眩/昏厥
  • 失去意識

根據克利夫蘭醫學中心 (一間非營利的學術醫療中心),約百分之 20 出現急性過敏的人會經歷兩階段急性過敏。若出現這種反應,患者會經歷部分前述的症狀,接著症狀會消失。然而,在第一波症狀發生後的數小時或甚至數天後,患者會經歷第二輪的嚴重症狀。3

有鑑於兩階段反應的風險,在曾經歷急性過敏反應的人看似恢復後,持續監控數小時甚至數天是非常重要的。 

什麼會造成急性過敏?

雖然可能還有其他因素造成急性過敏,例如運動, 但過敏原是最主要的肇因。其中,食物過敏原是兒童急性過敏最常見的誘發因子,而昆蟲毒液和和各種藥物過敏則是成人身上最普遍的誘發因子。7此外,根據一篇在《過敏及臨床免疫學期刊》上發表的研究,在澳洲、紐西蘭、英國、巴西和美國等國家中,藥物是致死性急性過敏最普遍的報告成因8

以下是一些可能造成急性過敏的最常見過敏種類,還有一些連結以協助您深入瞭解每種過敏。 

While a wide range of foods may cause anaphylaxis, the most commonly implicated foods for both adults and children worldwide are:

Other perhaps less-common causes of food-induced anaphylaxis may include:9-15

Natural rubber latex is found in items such as gloves, condoms, balloons, and more. Sometimes, latex causes only a mild skin irritation in sensitized individuals; other times it can trigger a severe allergic reaction. In fact, according to the Asthma and Allergy Foundation of America, inhaling small latex particles, perhaps from being in the vicinity of someone donning and/or removing latex gloves, may be enough to trigger a reaction.6

Anaphylaxis may also be caused by allergies to the following drugs and contrast agents:6,15-17

  • Penicillin and other antibiotics
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., aspirin and aspirin-related products
  • Insulin
  • Muscle relaxants (e.g., suxamethonium, alcuronium, vecuronium, pancuronium, and atracurium, which are widely used in general anesthesia)
  • Biologics and monoclonal antibodies
  • Contrast agents (i.e., special dyes to help internal body parts or functions show up better on scans) 

Venom from stinging insects (such as bees, yellow jackets, wasps, and hornets) and bites from fire ants may cause anaphylaxis.6 Anaphylaxis caused by insect-venom allergy has been reported in 3 percent of adults and 1 percent of children who’ve been stung.16 Additionally 80 to 90 percent of fatal insect venom anaphylaxis occurs in men 50 to 60 years old on average.8

急性過敏的風險因子有哪些?

雖然急性過敏難以預測,但有幾個因子可能會增加急性過敏的風險。 

  • 之前曾經歷急性過敏。對於曾經歷急性過敏的患者來說,風險會升高;此外,後續反應可能會更嚴重。1
  • 心血管疾病。根據一項研究,百分之 71 的致死性藥物急性過敏發生在心血管疾病患者身上。8
  • 肥大細胞增多症。雖然罕見,肥大細胞增多症是由身體組織中過量的肥大細胞所導致的。18視病症類型而定,雖然其會導致非常多症狀,但全身性肥大細胞增多症患者得到急性過敏的風險較高。16
  • 氣喘。根據一項近期的研究,在英國和澳洲,氣喘會影響百分之 70 至 75受致死性食物急性過敏所苦的人。8
  • 運動。運動引起的急性過敏通常發生於激烈的身體活動後。6症狀最初可能包括疲勞、潮紅和皮膚病症,例如蕁麻疹、膨疹和/或皮疹。16可能影響運動引起之急性過敏的其他風險因子包括藥物或酒精的使用、溫度和季節變化,以及運動前進食。6成人中,可能與此病症相關的最常見食物包括芹菜、貝類及甲殼類、乳酪、蕃茄和酒精。4
  • 其他因子。壓力、急性感染和月經前狀態也可能增加急性過敏的風險。8

您可以怎麼做以預防和治療急性過敏?

為降低急性過敏的風險,過敏患者必須先瞭解其對哪些過敏原會出現致敏反應,接著採取相應措施以減少暴露。辨識可能之誘發因子的最佳方法之一就是簡單的血液檢測

搭配您的症狀病史和身體檢查,過敏的特異性 IgE 血液檢測可協助您的醫療照護提供者確切判斷哪些過敏原可能引發過敏反應。此外,特異性 IgE 過敏原成分檢測 (以及其他因子) 可協助您的提供者更準確地預測您出現如急性過敏等嚴重反應的風險。  

若要為醫療就診做準備,您可以完成我們的症狀追蹤工具, 其會產出完整的症狀檔案,您可與醫療照護提供者一起檢閱,以判斷特異性 IgE 血液檢測是否適合您。

一旦辨識出您的誘發因子,您可以採取幾個步驟來準備和/或避免反應,並處理緊急狀況。

  • Wear a medical-alert ID, such as a necklace or bracelet.1  
  • Keep an emergency kit with any prescribed medications available at all times.1
  • Ensure any epinephrine autoinjectors (e.g., EpiPen, Jext, Emerade) are current (as opposed to expired).1
  • Provide personalized anaphylaxis information to anyone that interacts with children with severe allergies or a history of anaphylaxis. Ensure that everyone he or she regularly comes into contact with is aware of the risk and understands what to do an emergency situation. Consider informing people such as school nurses, teachers, daycare providers, coaches, neighbors, parents of the affected child’s friends, etc.19
  • Educate yourself about generic drugs and brand names for drugs that may cause reactions (if applicable). Be especially aware of ingredients in combination products and become familiar with drugs that could cause cross-reactions.6
  • Avoid food-allergen exposure (if applicable) via tactics such as:1,6
    • Reading food labels carefully to check for potential allergens,
    • Asking restaurants how each dish is prepared, what ingredients it contains, and what cross-contamination efforts are employed, and
    • Preventing cross contamination while cooking by washing hands, surfaces, utensils, etc.
  • Employ insect-venom-related precautions (if applicable), such as refraining from:1
    • Walking barefoot in the grass,
    • Wearing bright colors, perfumes, colognes, and scented lotions, which may attract insects, and
    • Drinking and/or eating from soda cans and containers that have been outdoors and may conceal insects. 
  • Ask your healthcare provider to create an anaphylaxis action plan to help you better prepare for an emergency.6
  • Educate your family, friends, and co-workers about your allergies (or those of your child) and how to recognize symptoms of anaphylaxis.3
  • Ensure all healthcare providers are aware of your allergies, especially if you plan to have a medical procedure.3
  • Learn more about exposure-reduction strategies specific to your unique allergic triggers via our more than 60 individual Allergen Fact Sheets.

If someone is showing signs of anaphylaxis—such as pale, cool, and clammy skin; a weak, rapid pulse; trouble breathing; confusion; and/or loss of consciousness—the Mayo Clinic suggests you immediately do the following:19

  • Call your local emergency phone number (e.g., 911 in the United States, 112 in Europe).
  • Make sure the person is lying down and elevate the legs.
  • Use an epinephrine autoinjector, if available.
  • Check the person's pulse and breathing, and if necessary administer CPR or other first-aid measures.

如需更多相關文章,請參閱我們網站的與過敏共存部分和過敏原基本資料,其提供 60 種以上過敏原的基本資訊和減少暴露的秘訣,包括黴菌寵物皮屑蟑螂塵蟎花粉α-半乳糖苷寡糖昆蟲毒液等。 

用於瞭解過敏的工具

 

追蹤過敏症狀並為就診醫療服務提供者做好準備。

瞭解特定過敏原,包括常見症狀、管理和緩解。 

您是醫療服務提供者嗎?取得有關數百種完整過敏原和分子過敏原的完整資訊。

  1. Mayo Clinic [Internet] Anaphylaxis. Rochester, MN: Mayo Foundation for Medical Education and Research; 2021 Oct. 2. Available from: https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468
  2. American Academy of Allergy, Asthma & Immunology [Internet] Allergic Reaction Defined. Milwaukee WI, American Academy of Allergy, Asthma & Immunology. Accessed July 2022. Available from:  https://www.aaaai.org/tools-for-the-public/allergy,-asthma-immunology-glossary/allergic-reaction-defined.
  3. Cleveland Clinic [Internet]. Cleveland OH: Cleveland Clinic; 2021 Jan 13. Available from: https://my.clevelandclinic.org/health/diseases/8619-anaphylaxis.
  4. Cianferoni A, Muraro A. Food-induced anaphylaxis. Immunol Allergy Clin North Am. 2012 Feb;32(1):165-95. doi: 10.1016/j.iac.2011.10.002. Epub 2011 Nov 21. PMID: 22244239; PMCID: PMC3440177. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440177/pdf/nihms339803.pdf
  5. American Academy of Allergy, Asthma & Immunology [Internet]. Milwaukee WI, American Academy of Allergy, Asthma & Immunology. Accessed July 2022. Available from: https://www.aaaai.org/conditions-treatments/allergies/anaphylaxis
  6. Asthma and Allergy Foundation of America [Internet]. Arlington, VA: Asthma and Allergy Foundation of America; 2017 Feb.  Available from: https://www.aafa.org/anaphylaxis-severe-allergic-reaction/
  7. Worm M, Babina M, Hompes S. Causes and risk factors for anaphylaxis. J Dtsch Dermatol Ges. 2013 Jan;11(1):44-50. doi: 10.1111/j.1610-0387.2012.08045.x. Epub 2012 Nov 26. PMID: 23181736. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1610-0387.2012.08045.x.
  8. Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal Anaphylaxis: Mortality Rate and Risk Factors. J Allergy Clin Immunol Pract. 2017 Sep-Oct;5(5):1169-1178. doi: 10.1016/j.jaip.2017.06.031. PMID: 28888247; PMCID: PMC5589409. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/#:~:text=Up%20to%205%25%20of%20the,with%20hospital%20admissions%20for%20anaphylaxis.
  9. Mayo Clinic [Internet] Alpha gal. Rochester, MN: Mayo Foundation for Medical Education and Research; 2021 Oct. 2. Available from: https://www.mayoclinic.org/diseases-conditions/alpha-gal-syndrome/symptoms-causes/syc-20428608.
  10. The University of Manchester [Internet]. Manchester, UK: The University of Manchester; 2006 Oct 18. Available from: http://research.bmh.manchester.ac.uk/informall/allergenic-food/index.aspx?FoodId=12.
  11. Anaphylaxis UK [Internet] Fruit. Accessed July 2022. Available from: https://www.anaphylaxis.org.uk/fact-sheet/vvegetables-allergy/.
  12. Anaphylaxis UK [Internet] Vegetables. Accessed July 2022. Available from: https://www.anaphylaxis.org.uk/fact-sheet/fruit-allergy/.
  13. Food Allergy Canada [Internet]. Toronto, Canada. Accessed July 2022. Available from: https://foodallergycanada.ca/allergies/mustard.
  14. American College of Allergy, Asthma & Immunology [Internet] Arlington Heights, IL: American College of Allergy, Asthma & Immunology. Accessed July 2022. Available from: https://acaai.org/allergies/allergic-conditions/food.
  15. Lockey R. World Allergy Organization [Internet]. Milwaukee, WI: World allergy Organization; 2019 April. Available from: https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/anaphylaxis-synopsis.
  16. Irani, Anne-Marie, and Elias G Akl. “Management and Prevention of Anaphylaxis.” F1000Research vol. 4 F1000 Faculty Rev-1492. 22 Dec. 2015, doi:10.12688/f1000research.7181.1 Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754021/pdf/f1000research-4-7737.pdf
  17. NHS [Internet]. United Kingdom. 2021 Nov 1. Available from: https://www.nhs.uk/conditions/anaphylaxis.
  18. NHS [Internet] Mastocytosis. United Kingdom. 2019 June 19. Available from: https://www.nhs.uk/conditions/anaphylaxis. Available from: https://www.nhs.uk/conditions/mastocytosis.
  19. Mayo Clinic [Internet] Anaphylaxis Diagnosis. Rochester, MN: Mayo Foundation for Medical Education and Research; 2021 Oct. 2. Available from: https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468