红肉诱发严重过敏反应的临床病例研究

Clinical Case Study on Anaphylaxis Induced by Red Meat Ingestion

目的自2009年起,澳大利亚、美国和欧洲相继报道了一种新型食物过敏病例,患者在进食红肉3-6 h后发生严重过敏反应,这种疾病被认为和蜱叮咬及非灵长类哺乳动物阿尔法半乳糖Ig E抗体相关。病例散发于各大洲,本文为我国首次报道。方法对2例进食红肉后迟发严重过敏反应患者的临床表现进行总结并进行蜱叮咬问卷调查。病例1血清和健康对照血清分别与哺乳动物肉和内脏进行免疫印迹实验,观察其特异性结合特点。结果病例1为57岁女性,病例2为44岁男性,均为北京郊县农民。2例患者均在进食红肉后3-6 h多次发生严重过敏反应。患者血清多种哺乳动物蛋白皮肤试验和Ig E抗体均为阳性,且阿尔法半乳糖特异性Ig E均为阳性（分别为6级〉100 k UL和3级6.00 k UL）。病例1在发病前有蜱叮咬史,捕获其家犬身上蜱,经鉴定为长角血蜱。病例2在发作前无明确蜱叮咬病史。血清免疫印迹实验结果提示病例1血清Ig E与动物肌肉组织和内脏组织均有特异性结合,其中动物内脏阿尔法半乳糖表型表达高于肌肉组织。结论红肉过敏可导致严重临床症状,威胁患者生命。这一疾病可由蜱叮咬引起,值得公众及临床医生关注。确诊为红肉过敏的患者应避免进食相关肉类和内脏等组织。

Objective Anoveldelayedanaphylacticreactiontoredmeat,associatedwithtickbitesandIgE antibodies against galactose-α-1 ,3-galactose （α-gal）,was reported in Australia,US,and Europe since 2009.ThisisthefirstclinicalcasestudyofredmeatinduceddelayedanaphylaxisinChina.Method Two cases of delayed anaphylactic reactions to red meat were reported for the first time in China. Clinical manifestations were summarized,allergens were investigated,and questionnaire about tick bite was taken as well. Analysis of the antigen-binding characteristics of serum specific IgE antibodies with pork,innards were performed,based on western blotting by using sera from case 1 and a healthy control to observe the features ofspecificbindingcharacteristics.Results Thetwocases（case1female/57yrs,case2male/44yrs）are both farmers who live in the suburb of Beijing,manifested with anaphylactic reactions three to six hours after red meat ingestion. Serum specific IgE and skin test results to multiple mammalian proteins were positive.＆amp;nbsp;Specific IgE to galactose-α-1 ,3-galactose were positive in the two patients （〉100 kU/L in case 1 and 6. 00 kU/L in case 2 ）.Case 1 reported a history of tick biting with large regional reactions 2-3 weeks before anaphylaxis. The ticks on her dog were captured and authenticated as hematophagous ixodidae. Case 2 did not report history of tick bites. The increased concentration of IgE reactive epitopes in mammalian organs wasconfirmedbyusingwesternblottingwithserumofcase1.Conclusions Ingestionofredmeatcan induce severe and sometimes life-threatening clinical manifestations,which might be induced by tick bite. This issue should arouse concerns both in public and doctors. Patients with red meat allergy should avoid intake of meat as well as innards of non-primate mammalian.