1型超敏反应代表急性IgE介导的反应,可引起危及生命的疾病,比如过敏性休克,血管性水肿,和气道阻塞。其他可以模拟1型超敏反应的反应包括非IgE依赖性肥大细胞脱颗粒,缓激肽介导的反应,白三烯介导的反应,和伪过敏。我们在本文中使用术语假性过敏来表示不依赖肥大细胞的组胺介导的反应。我们没有讨论不是急性或危及生命的假性过敏反应,如乳糜泻,海纳综合征,嗜酸性粒细胞性食管炎,和食物蛋白引起的小肠结肠炎在我们的文章,因为急诊科不是诊断或治疗这些反应的主要位置。在这里,我们会出现一些类似过敏的反应,可能危及生命,如scomboid食物中毒(SFP),缓激肽诱导的血管性水肿,非IgE依赖性血管性水肿,阿片类药物诱导的血管性水肿,和非甾体抗炎药(NSAID)引起的超敏反应和血管性水肿。这些反应可基于它们的反应机理而具有不同的处理。组胺介导的反应,例如SFP,组胺介导的血管性水肿,和NSAIDs诱导的肥大细胞脱颗粒,阿片类药物可以用抗组胺药治疗,肾上腺素,和皮质类固醇。缓激肽诱导的血管性水肿,包括遗传性血管性水肿和获得性血管性水肿,可以用新鲜冷冻血浆治疗。遗传性血管性水肿可以用许多FDA批准的靶向药物治疗,例如血浆衍生的C1-INH,血浆激肽释放酶抑制剂(Ecallantide),和选择性缓激肽-2受体拮抗剂(Icatibant)。然而,这些靶向药物的研究不足以用于获得性血管性水肿.急诊医师熟悉并预测这些反应以防止误诊是至关重要的。准备好及时治疗这些危及生命的疾病,并消除患者暴露于任何不必要的调查或治疗。
Type-1 hypersensitivity reaction represents an acute IgE-mediated reaction that can cause life-threatening conditions, such as anaphylactic shock, angioedema, and airway obstruction. Other reactions that can mimic type-1 hypersensitivity reactions include IgE-independent mast cell degranulation, bradykinin-mediated reactions, leukotrienes-mediated reactions, and pseudo-allergies. We use the term pseudo-allergy in this article for histamine-mediated reactions that are mast cell-independent. We did not discuss pseudo-allergic reactions that are not acute or life-threatening, such as celiac disease, Heiner\'s syndrome, eosinophilic esophagitis, and food protein-induced enterocolitis in our article because the emergency department is not the primary location to diagnose or treat these reactions. Herein, we present some allergic-like reactions that can be life-threatening, such as scombroid food poisoning (SFP), bradykinin-induced angioedema, IgE-independent angioedema, opioid-induced angioedema, and non-steroidal anti-inflammatory drug (NSAID)-induced hypersensitivity and angioedema. These reactions may have different treatments based on their mechanism of reaction. Histamine-mediated reactions, such as SFP, histamine-mediated angioedema, and mast cell degranulation induced by NSAIDs, and opioids can be treated with antihistamines, epinephrine, and corticosteroids. Bradykinin-induced angioedema, including hereditary angioedema and acquired angioedema, can be treated with fresh frozen plasma. Hereditary angioedema can be treated with many FDA-approved targeted medications, such as plasma-derived C1-INH, plasma kallikrein inhibitor (Ecallantide), and selective bradykinin-2 receptor antagonist (Icatibant). However, these targeted agents are not well-studied enough to be used for acquired angioedema. It is crucial for emergency medicine physicians to be familiar with and predict these reactions to prevent misdiagnosis, be prepared to treat these life-threatening conditions appropriately without delay and eliminate patients\' exposure to any unnecessary investigations or treatments.