阿司匹林相关小麦依赖运动诱发过敏性休克：20例回顾性分析

摘要

目的：分析阿司匹林相关小麦依赖运动诱发过敏性休克（aspirin related wheat-dependant exercise-induced anaphylaxis，aspirin related，WDEIA）患者临床特点。方法回顾性分析2008年9月至2013年12月北京协和医院变态反应科确诊的20例阿司匹林相关 WDEIA 病例资料。结果20例患者中男13例，女7例；平均发病年龄为55（41～70）岁；常规服用阿司匹林40～150 mg/d。70％（14/20）合并慢性荨麻疹，40％（8/20）常规服用阿司匹林后原有荨麻疹症状加重或休克频率增加。20例患者均检测了3种小麦蛋白（水溶蛋白、面筋、ω-5醇溶蛋白）特异性 IgE（specific IgE，sIgE），阳性率分别为50％（10/20）、90％（18/20）和100％（20/20）。在有详细病史记录的50次过敏性休克中，62％（31/50）发生在运动过程中；12％（6/50）休克发作与运动无关，加重因素仅有阿司匹林。84％（42/50）表现为重度过敏性休克。14例患者有随访记录，其中50％（7/14）确诊后停用阿司匹林并严格禁食小麦类食物未再次发作休克；29％（4/14）仅停用阿司匹林，进食面食后避免剧烈运动，未再次发作荨麻疹或严重过敏反应；21％（3/14）患者仅严格禁食小麦制品未停用阿司匹林，无荨麻疹或过敏性休克发作。结论低剂量阿司匹林可诱发或加重食物诱发过敏性休克症状，阿司匹林相关 WDEIA 患者停用阿司匹林并严格禁食小麦制品可避免休克发作。%Objective To analyze clinical feature of aspirin-related wheat dependent exercise induced anaphylaxis(aspirin-related WDEIA).Methods Clinical data collected from patients were analyzed retrospectively,who were diagnosed as “aspirin-related WDEIA”in Allergy Department of PUMCH from September 1 ,2008 to December 31 ,2013.Results Twenty patients(13 males and 7 females)were enrolled,the average age of onset was 55 (range:41 -70)years old.The regular dose of aspirin was 40-150 mg/day.70%(14/20)of patients associated with chronic urticaria.Specific IgE of three kinds of wheat proteins(wheat,gluten and omega-5 gliadin)were detected among patients,the positive rate was 50%,90%,and 100% respectively.Among 50 attacks with detailed clinical records,31 /50 (62%) episode occurred during exercise,aspirin as the only cofactor in 6/50(12%).42/50(84%)were severe life-threatening.14 patients were followed up,7 /14 (50%)patients were not attacked by anaphylaxis again after avoidance taking aspirin and wheat.4/14 (29%)patients can eat wheat without severe reactions after avoiding exercise and stopping aspirin intake.No further episodes occurred among 3/14 (21%)patients after complete avoiding of wheat intake without stopping aspirin taking.Conclusions Low dose aspirin is a risk factor for food induced anaphylaxis.Patients with aspirin related WDEIA should avoid aspirin and wheat product intake strictly.