44例蜜蜂蜂毒过敏的临床特点

Clinical Features of 44 Cases of Honey Bee Venom Allergy

目的探讨蜜蜂蜂毒过敏的临床特点。方法回顾2002年6月至2012年2月到北京协和医院就诊并确诊的蜜蜂蜂毒过敏患者及同时期因过敏性疾病在北京协和医院变态反应科就诊,无蜜蜂蛰刺过敏反应的相关临床病史,但蜜蜂蜂毒血清sIgE检测阳性的对照组患者资料;根据蜜蜂蜇刺后的过敏反应类型将研究组分为局部反应组、大局部反应组和全身反应组。分析蜜蜂蜂毒过敏患者生活地域、暴露类型等特点,比较各研究组和对照组之间的IgE比活性(IgE specific activity,sIgE/T-IgE)。结果研究组44例,男女之比为31:13,平均年龄37(29,48)岁,48%(21/44)生活在市区,52%(23/44)生活在郊区。局部反应组30例、大局部反应组6例、全身反应组8例。全身反应组中II级1例、III级7例。蜂毒暴露类型构成比的研究组间差异有统计学意义(P=0.0085),全身反应组中50%(4/8)为养蜂者。局部反应组、大局部反应组、全身反应组及对照组sIgE/T-IgE组间差异有统计学意义(P=0.001),全身反应组与对照组sIgE/T-IgE差异有统计学意义[3.51%(1.19%,8.84%)vs.0.16%(0.09%,0.49%),P=0.001]。全身反应组中1例在首次蜜蜂蜇刺时为大局部反应,3个月后再次蜜蜂蜇刺出现II级全身性严重过敏反应。结论蜜蜂蜂毒导致全身性严重过敏反应以职业性暴露最为常见,使用sIgE/T-IgE有助于正确诊断蜜蜂蜂毒过敏。

Objective To investigate the clinical characteristics of honey bee venom allergy. Methods Clinical data were collected and summarized from patients who were diagnosed as honeybee venom allergy or other allergic diseases without relevant clinical history of honeybee venom sting reaction but whose honeybee venom （il） slgE results were positive from Department of Allergy, PUMC hospital since June 2002 to February 2012. Based on honeybee sting reactions, patients were divided into three groups： local reactions, large local reactions and systemic reactions. Habitual residence and exposure types of the patients were analyzed. The sIgE/T-IgE was compared between allergy and control group. Results 44 patients were enrolled into allergy group, male versus female was 31： 13; average age was 37 （between 29 and 48 years old）. 48% （21/44） of them lived in urban areas and 52% （23/44） lived in the rural areas. 30/44 of the cases were suffering from local reactions, 6/44 of the cases from large local reactions and 8/44 of the cases from systemic reactions. 1/8 of the case was graded as type II and 7/8 of the cases as type III in systemicreaction group. The differences were statistically significant （P = 0. 0085） among three groups on exposure types. 50% （4/8） of patients were beekeepers in systemic reaction group. There is statistically significant difference （P =0. 001 ） among allergy and control groups on sIgE/T-IgE. The differences were statistically significant between systemic reaction and control group on sIgE/T-IgE [ 3.51% （1.19%, 8.84% ）vs. 0. 16% （0.09% , 0. 49% ） , P =0. 001 ]. One patient in systemic reaction group was suffering from local reaction only during first sting and attacked by type II systemic reaction when he was stung again three months later. Conclusions Occupational exposure was the most common cause of honeybee venom systemic reaction, slgE/T-IgE could be a helpful tool for the diagnosis of honeybee venom allergy.