蜂疗致蜂毒过敏的临床特征及影响因素

Clinical manifestations and risk factors of honeybee venom allergy induced by apitherapy

目的调查接受蜂疗的人群中蜂毒过敏的患病率和临床特征,并分析其危险因素。方法 2017年12月至2018年1月在石家庄、广州、深圳对开展蜂疗的中医医院进行横断面调查。对接受蜂疗的患者进行问卷调查,并对出现过大局部反应、全身反应的受访者进行蜂毒变应原皮肤点刺试验(SPT)。结果共调查127例接受蜂疗者,其中3例因未接受SPT而排除,共纳入124例,包括石家庄(华北地区)77例,广州和深圳(华南地区)47例。女性占68.5%;平均年龄(50.8±16.6)岁。41例在蜂疗中出现变态反应并接受了SPT;36例经SPT确诊为蜂毒过敏,占29%,其中5例出现过大局部反应的受访者SPT结果阴性,纳入非变态反应组。大局部反应者22例,占17.7%,全身反应者14例,占11.3%。35.7%(5/14)全身反应者曾经历过大局部反应。在调整了蜂疗起始年龄、性别、地域、基础疾病、变态反应等因素后,蜂疗频率是蜂毒过敏的影响因素(OR=0.838,95%CI:0.708~0.991)。结论接受蜂疗人群中蜂毒过敏情况不容忽视,对于高危人群尤需密切随访并配备急救药物和设备,增加蜂疗频率是蜂毒过敏的保护因素。

Objective To investigate the incidence and clinical findings of honeybee venom allergy（ HVA） in the population who received apitherapy and analyze its risk factors. Methods A multicenter cross-sectional study in the patients with apitherapy was performed in Shijiazhuang Dazheng Apitherapy Hospital（ in North China）,First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine and Shenzhen Traditional Chinese Medicine Hospital（ in South China） during December 2017 and January 2018. Clinical data and manifestations induced by apitherapy were collected and analyzed. The diagnosis of HVA was confirmed based on positive results of skin prick test（ SPT） to honeybee venom.Results One hundred and twenty-four patients were enrolled in the analysis. Women accounted for68. 5%; the average age was（ 50. 8 ± 16. 6） years old. Allergic reaction occurred after apitherapy and SPT was carried out in 41 patients. The diagnosis of HVA was confirmed in 29%（ 36/124） patients with adverse reactions after apitherapy basing on positive SPT results. The prevalence of large local and systemic reaction after apitherapy was 17. 7% and 11. 3%,respectively. 35. 7%（ 5/14） patients with systemic reaction experienced large local reactions prior to system symptoms after apitherapy. The negative correlation between apitherapy frequency and risk of HVA was shown after controlling initial age,gender,area,general diseases,and allergic history by Logistic regression analysis（ OR = 0. 838,95% CI： 0. 708-0. 991）.Conclusions HVA is common during apitherapy and should not be ignored. For the patients with high risk factors,close observation after apitherapy and an emergency kit contained epinephrine are necessary. Regular apitherapy may decrease the risk of HVA.