每日一题_2022.07.02

A 34-year-old woman with a penicillin allergy is recovering from an open hemicolectomy in the ICU. Her pain is well controlled with an epidural. She receives piperacillin/tazobactam antibiotic by mistake and subsequently develops severe systemic patchy erythema, wheezing, and hypotension. She is immediately treated with epinephrine, and clinically improves. Twelve hours later, she develops wheezing and hypotension. Which of the following is the most likely cause of her new symptoms?

A. Administration of penicillin antibiotic

B. Migration of epidural catheter into the intrathecal space 

C. Anastomotic leak

D. Relapse of anaphylaxis

答案解析：

免疫介导反应或直接非免疫介导反应可导致过敏反应。初始致敏后发生免疫过敏反应。第二次暴露产生免疫介导（最常见的是 IgE 介导）反应，导致肥大细胞和嗜碱性粒细胞释放炎症介质。围手术期引起免疫过敏反应的常见药物/暴露包括神经肌肉阻滞药物 (NMBD)、抗生素和乳胶。

肥大细胞和嗜碱性粒细胞直接激活后发生非免疫性过敏反应，无免疫学参与。这可能发生在首次暴露时，而不需要先决条件暴露进行致敏。常见的例子包括万古霉素、吗啡和低温暴露。任何可产生非免疫反应的药物也有可能产生免疫介导的反应。

速发过敏反应可能在初始事件后72小时（中位11小时）内复发，有1-20%的患者报告。其机制尚不清楚，但可能是由过敏反应药物的血浆浓度降低或真正的免疫现象引起的。发生重度超敏反应后，强烈建议在 ICU 密切观察长达72小时。

正确答案：D