哺乳动物肉类过敏患者的临床特点

Clinical characteristics of mammalian meat allergy

目的分析13例中国哺乳动物肉类过敏患者的病史及辅助检查结果及其临床特点,为哺乳动物肉类过敏的临床诊断提供参考依据。方法对在北京协和医院变态(过敏)反应科就诊的可疑哺乳动物肉类过敏患者采集病史,并完成皮肤点刺试验、皮内试验及体外血清特异性免疫球蛋白E (s Ig E)检测,分析患者的临床特点。结果北京协和医院变态(过敏)反应可共确诊哺乳动物肉类过敏患者13例,中位病程35个月,多于进食肉类3～5 h后发病,仅1例患者于餐后10 min即发病。所有患者均有荨麻疹、瘙痒的皮肤症状(100%),9例有胸闷、喘憋等呼吸道症状,占69. 2%;9例有呕吐、腹痛、腹泻等消化道症状,占69. 2%; 8例存在心悸、晕厥等心血管系统症状,占61. 5%。患者中A型或O型血(非B型血)者占84. 6%,38. 5%的患者有明确的蜱叮咬病史。辅助检查结果显示,66. 7%的患者哺乳动物肉类皮肤点刺试验阳性,100%患者皮内试验阳性,84. 6%患者猪肉s Ig E检测阳性,76. 9%患者α-Gal s Ig E检测阳性。结论本文首次总结了国内13例哺乳动物肉类过敏患者的临床特点,其临床表现与国外报道的不同之处在于多数病例没有明确的蜱叮咬史,且有1例为典型速发变态反应。迅速发作的反应是否基于α-Gal表位以外的变应原组分尚有待进一步研究。

Objective Mammalian meat allergy is one kind of delayed-onset IgE-mediated allergic reaction after ingestion of mammalian meat,and its related allergen epitope is a carbohydrate moiety galactose-α-1,3-galactose(α-Gal).The clinical history and results of assistant examinations of 13 Chinese cases of mammalian meat allergy were analyzed and clinical features were also summarized in this study.Methods Suspected cases of mammalian meat allergy were collected from Department of Allergy,Peking Union Medical College Hospital.The clinical history was recorded;skin prick tests,intradermal tests and serum specific immunoglobulin E(sIgE)tests were performed.Results Diagnosis of mammalian meat allergy was confirmed among 13 patients,whose median course of disease was 35 months.Delayed onset of allergic symptoms was reported by most patients,which were defined as manifestations occurring 3-5 hours after the ingestion of mammalian meat.Only one patient described the rapid onset of symptoms,only 10 minutes after eating meat.The most common symptoms were urticaria and cutaneous itching(100%).Nine patients(69.2%)were attacked by dyspnea or wheezing,and also nine patients(69.2%)were suffering from vomiting,diarrhea or abdominal pain,while eight patients(61.5%)with palpitation or syncope.84.6%of patients belonged to the B-negative blood groups(type A and type O),and only 38.5%with history of tick bites.Positive results of mammalian meat skin prick tests were shown among 66.7%of cases,while positive results of intradermal tests were shown among 100%patients.Positive pork-andα-Gal-sIgE detection results were shown among 84.6%and 76.9%of patients respectively.Conclusions The clinical features of 13 Chinese patients with mammalian meat allergy were summarized first time in China,whereas partial clinical features were different from published literatures.Most patients denied history of tick bites and one cases reported typical immediate allergic reaction,whose onset of symptoms was within 10 minutes after eating the mammalian meat in our group.Further investigation should be done to clarify the potential existence of another epitope besidesα-Gal which was related to immediate allergic reaction after ingestion of mammalian meat.