疫苗明胶过敏2例及文献复习  

Gelatin-contained vaccine allergy induced anaphylaxis: two cases report and literature review

作　　者：李丽莎 文利平 关凯 LI Li-sha;WEN Li-ping;GUAN Kai(Department of Allergy,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院变态(过敏)反应科过敏性疾病精准诊疗研究北京市重点实验室,北京100730

出　　处：《中华临床免疫和变态反应杂志》2018年第4期409-416,共8页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的报道在中国确诊为疫苗中明胶过敏的病例,总结明胶速发型变态反应的临床特点。方法收集并报道国内2例疫苗接种后由明胶成分引起的速发型变态反应儿童病例,同时在Pubmed网站、中国知网、万方数据库及维普数据库在线检索近50年发表的关于明胶速发型变态反应的相关文献,选择文献中符合纳入标准的病例进行总结,对明胶速发型变态反应的临床特点和检查方法进行分析。结果在国内首次报道了2例确诊的由疫苗明胶成分引起的速发型全身变态反应儿童病例。将满足检索策略和纳入标准的59篇英文文献和36篇中文纳入分析,共有380例明胶速发型变态反应患者。这些患者发病常见2个诱因,即含有明胶成分的疫苗接种和静脉滴注明胶液体,分别占55. 0%和30. 5%。明胶注射液过敏患者中重度变态反应的比例为86. 2%,明显高于疫苗接种途径的27. 3%和食物途径的33. 3%。同时完成皮肤试验和实验室明胶特异性免疫球蛋白E (sIgE)测定的患者中,96. 3%的患者皮肤试验呈阳性反应,仅有48. 1%的患者sIgE检测结果为阳性。结论明胶注射液静脉滴注比疫苗接种或食物更容易引起重度全身变态反应;明胶过敏的辅助诊断方法中,皮肤试验法的敏感性高于实验室sIgE检测法。Objective Two Chinese cases of gelatin-contained vaccine induced anaphylaxis were reported and the clinical features of immediate allergic reaction to gelatin were summarized basing on literatures. Methods The characteristics of patients with immediate allergic reaction to gelatin was reviewed in this article based on the search results of multiple domestic and international databases. Results Two cases of pediatric patients with immediate systemic allergic reaction to gelatin-contained vaccines were first reported in China. Fifty-nine articles in English and another 36 in Chinese were eligible in the past 50 years and reviewed in this paper, including 380 patients with immediate hypersensitivity to gelatin. 55.0% of them were induced by gelatin-contained vaccines and 30.5% by gelatin-contained plasma substitute. 86.2% of gelatin-contained plasma substitute-induced systemic allergic reaction was graded as severe reaction, which was significantly higher than that induced by gelatin-contained vaccines （27.3%） or gelatin-contained food （33.3%）. The positive rate of gelatin skin test and serum IgE detection results were 96.3% and 48.1%, respectively,among the patients who were prescribed both in vivo and in vitro tests. Conclusions Severe systemic allergic reaction is more likely induced by gelatin-contained plasma substitutes in compared to gelatin-contained vaccines or food. The sensitivity of skin test is higher than that in vitro sIgE detection as assistant diagnostic methods for gelatin allergy.

关 键 词：明胶 变态反应 疫苗 血浆代用品 

分 类 号：R593.1[医药卫生—内科学]