Russian Journal of AllergyRussian Journal of AllergyРоссийский Аллергологический Журнал1810-88302686-682XPublishing House ABV Press9710.36691/RJA97ArticlesСтатьиResearch ArticleCurrent aspects of pathogenesis, diagnostics and treatment of idiopathic anaphylaxisСовременные аспекты патогенеза, диагностики и лечения идиопатической анафилаксииEsakovaN VЕсаковаНаталья Владиславовна

кандидат медицинских наук, научный сотрудник отдела аллергологии и клинической иммунологии

env007@rambler.ruPampuraA NПампураАлександр Николаевич

доктор медицинских наук, зав. отделом аллергологии и клинической иммунологии

Academician Yu.E. Veltishchev Research Clinical Institute of Pediatrics N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian FederationОСП «Научно-исследовательский клинический институт педиатрии им. академика Ю.Е. Вельтищева» ФГБОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России14122018156NO6 (2018)№6 (2018)263210032020Copyright ©; 2018, Pharmarus Print MediaCopyright ©; 2018, Фармарус Принт Медиа2018Pharmarus Print MediaФармарус Принт Медиаhttps://rusalljournal.ru/raj/article/view/97

Anaphylaxis is defined as a serious generalized allergic or hypersensitivity reaction that is rapid in onset and might cause the death. In some cases, anaphylaxis occurs without a specific inducing trigger, and in this situation, after unsuccessful diagnostics, anaphylactic reaction is called idiopathic. Patients with idiopathic anaphylaxis are about 1/3 of total number of patients with lifethreatening anaphylaxis. Current data on the prevalence, pathogenesis, diagnostics and treatment of idiopathic anaphylaxis are given in the article.

Анафилаксия представляет собой остро развивающуюся аллергическую реакцию, которая возникает внезапно и может явиться причиной смерти. В ряде случаев анафилаксия возникает при отсутствии определенного индуцирующего фактора, и в этой ситуации после обширного, но безуспешного диагностического поиска анафилактическая реакция называется идиопатической. Пациенты с идиопатической анафилаксией в среднем составляют порядка 1/3 от общего числа больных, страдающих жизнеугрожающими анафилактическими реакциями, что определяет актуальность данной нозологии для практической медицины. В статье представлен анализ современных данных о распространенности, патогенезе, принципах диагностики и лечения идиопатической анафилаксии.

idiopathic anaphylaxisanaphylaxisanaphylactic reactionидиопатическая анафилаксияанафилаксияанафилактическая реакцияSampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF, Bock SA, Branum A et al. Second symposium on the definition and management of anaphylaxis: summary report - Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117:391-397. DOI: 10.1016/j. jaci.2005.12.1303.Greenberger PA. Idiopathic anaphylaxis. Immunol Allergy Clin N Am. 2007;27:273-293. DOI: 10.1016/j.iac.2007.03.009.Fenny N, Grammer LC. Idiopathic anaphylaxis. Immunology and Allergy Clinics of North America. 2015;35:349-362. DOI: 10.1016/j.iac.2015.01.004.Kuhlen JL, Virkud YV Pathogenesis, newly recognized etiologies, and management of idiopathic anaphylaxis. Discov Med. 2015;19:137-144.Nwaru BI, Dhami S, Sheikh A. Idiopathic Anaphylaxis. Curr Treat Options Allergy. 2017;4:312-319. DOI: 10.1007/s40521-017-0136-2.Bacal E, Patterson R, Zeiss CR. Evaluation of severe (anaphylactic) reactions. Clin Allergy. 1978;8:295-304.Lieberman PL. Idiopathic anaphylaxis. Allergy Asthma Proc. 2013;35:17-23. DOI: 10.2500/aap.2014.35.3717.Ditto AM, Patterson R, Sider L. Allergic bronchopulmonary aspergillosis, idiopathic anaphylaxis and cystic fibrosis in a 9 year old: a case report. Pediatr Asthma Allergy Immunol. 1995;9:107-115.Dykewicz MS, Blaser M, Evans R, Patterson R. Pediatric idiopathic anaphylaxis: a report of 3 cases with recommendations for evaluation and management. Pediatr Asthma Allergy Immunol. 1990;4:217-223.Patterson R, Ditto A, Dykewicz MS, Greenberger PA, Harris KE, Kelly KJ et al. Pediatric idiopathic anaphylaxis: additional cases and extended observations. Pediatr Asthma Allergy Immunol. 1995;9:43-47.Ditto AM, Kransnick J, Greenberger PA, Kelly KJ, McGrath K, Patterson R. Pediatric idiopathic anaphylaxis: experience with 22 patients. J Allergy Clin Immunol. 1997;100:320-326.Hogan MB, Kelly MA, Wilson NW Idiopathic anaphylaxis in children. Ann Allergy Asthma Immunol. 1998;81:140-142. DOI: 10.1016/S1081-1206(10)62800-1.Patterson R, Hogan M, Yarnold P et al. Idiopathic anaphylaxis. An attempt to estimate the incidence in the United States. Arch Intern Med. 1995;155:869-871.Kemp SF, Lockey RF, Wolf BL, Lieberman P Anaphylaxis, a review of 266 cases. Arch Intern Med. 1995;155:1749-1754.Webb LM, Lieberman P. Anaphylaxis: a review of 601 cases. Ann Allergy Asthma Immunol. 2006;97:39-43. DOI: 10.1016/ S1081-1206(10)61367-1.Yocum MW, Butterfield J, Klein J, Volcheck GW, Schroeder DR, Silverstein MD. Epidemiology of anaphylaxis in Olmstead County, a population-based study. J Allergy Clin Immunol. 1999;104:452-456.Wood R, Camargo C, Lieberman P, Sampson HA, Schwartz LB, Zitt M et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133:461-467. DOI: 10.1016/j. jaci.2013.08.016.Ditto AM, Harris KE, Karsnick J, Miller MA, Patterson R. Idiopathic anaphylaxis: a series of 335 cases. Ann Allergy Asthma Immunol. 1996;77:285-291. DOI: 10.1016/S1081-1206(10)63322-4.Tejedor AM, Dominguez J, Sanchez-Hernandez J, Frances C, Caballer B. Idiopathic anaphylaxis: adescriptive study of 81 patients in Spain. Ann Allergy Asthma Immunol. 2002;88:313-318.Bourke J, Finucane J, O’Loughlin S. Idiopathic anaphylaxis. Ir Med J. 1997;90:62.Sonin L, Patterson R. Metbisulfite challenge in patients with idiopathic anaphylaxis. J Allergy Clin Immunol. 1985;75:67-69.Reed J, Yedulapuram M, Lieberman P, Fitzpatrick E. Differences in cytokine production between idiopathic anaphylaxis (IA) subjects and controls. J Allergy Clin Immunol. 2006;117:305.Slater JE, Raphael G, Cutler GB. Recurrent anaphylaxis in menstruating women: treatment with luteinizing hormone releasing hormone - a preliminary report. Obstet Gynecol. 1987;70:542-546.Grammer LC, Shaughnessy MA, Harris KE, Goolsby CL. Lymphocyte subsets and activation markers in patients with acute episodes of idiopathic anaphylaxis. Ann Allergy Asthma Immunol. 2000;85:368-371. DOI: 10.1016/S1081-1206(10)62547-1.Garriga MM, Friedman MM, Metcalfe DD. A survey of the number and distribution of mast cells in the skin of patients with mast cell disorders. J Allergy Clin Immunol. 1988;82:425-432.Tedeschi A, Lorini M, Suli C, Cugno M. Detection of serum histamine-releasing factorsin a patient with idiopathic anaphylaxis and multiple drug allergy syndrome. J Investig Allergol Clin Immunol. 2007;17:122-125.Grant JA, Alam R, Lett-Brown MA. Histamine-releasing factors and inhibitors: historical perspectives and possible implications in human illness. J Allergy Clin Immunol. 1991;88:683-693.Mozelsio N, Grammer L. Quantitation of monocyte chemoattractant protein-1 in patients with idiopathic anaphylaxis. J Allergy Clin Immunol. 2001;107:80.Keffer J, Bressler RB, Wright R, Kaliner MA, Metcalfe DD. Analysis of the wheal and flare reactions that follow the intradermal injection of histamine and morphine in adults with recurrent, unexplained anaphylaxis and systemic mastocytosis. J Allergy Clin Immunol. 1989;83:595-601.Tejedor MA, Perez C. Mast cell releasibility in idiopathic anaphylaxis subtypes. J Allergy Clin Immunol. 2000;105:348.Tejedor MA. Sastre DJ, Sanchez-Hernandez JJ, Perez FC, Hoz CB. Clinical and functional differences among patients with idiopathic anaphylaxis. J Invest Allergol Clin Immunol. 2004;14:177-186.Muraro GR, Clark A, Eigenmann P, Eigenmann PA, Halken S, Lack G et al. The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy 2007;62:857-871. DOI: 10.1111/j.1398-9995.2007.01421.x.Patterson R, Stoloff RF, Greenberger PA, Grammer LC, Harris KE. Algorithms for the diagnosis and management of idiopathic anaphylaxis. Ann Allergy. 1993;71:40-44.Choy C, Patterson R, Patterson DR, Grammer LC, Greenberger PA, McGrath KG et al. Undifferentiated somatoform idiopathic anaphylaxis: nonorganic symptoms mimicking idiopathic anaphylaxis. J Allergy Clin Immunol. 1995;96:893-900.Kaliner M, Dyer J, Merlins S. Increased urinary histamine in contrast media reactions. Invest Radiol. 1984;19:116.Shanmugam G, Schwartz LB, Khan DA. Prolonged elevation of serum tryptase in idiopathic anaphylaxis. J Allergy Clin Immunol. 2006;117:950-951. DOI: 10.1016/j.jaci.2005.12.1356.Sristava S, Huissoon AP, Barrett V, Hackett S, Dorrian S, Cooke MW et al. Systemic reactions and anaphylaxis with an acute serum tryptase >14 μg/L: retrospective characterisation of aetiology, severity and adherence to National Institute of Health and Care Excellence (NICE) guidelines for serial tryptase measurements and specialist referral. J Clin Pathol. 2014;67:614-619. DOI: 10.1136/jclinpath-2013-202005.Akin C, Scott LM, Kocabas cN, Kushnir-Sukhov N, Brittain E, Noel P et al. Demonstration of an aberrant mast-cell population with clonal markers in asubset of patients with «idiopathic» anaphylaxis. Blood. 2007;110:2331-2333. DOI: 10.1182/blood-2006-06-028100.Есакова НВ, Конюкова НГ Анафилаксия у детей раннего возраста. Российский Аллергологический Журнал. 2018;(3):35-42Stricker WE, Anorve Lopez E, Reed CE. Food skin testing in patients with idiopathic anaphylaxis. J Allergy Clin Immunol. 1986;77:516-519.Heaps A, Carter S, Selwood C, Moody M, Unsworth J, Deacock S et al. The utility of the ISAC allergen array in the investigation of idiopathic anaphylaxis. Clin Exp Immunol. 2014;177:483-490. DOI: 10.1111/cei.12334.Carter MC, Ruiz-Esteves KN, Workman L, Lieberman P, Platts-Mills TAE, Metcalfe DD. Identification of alpha-gal sensitivity in patients with a diagnosis of idiopathic anaphylaxis. Allergy. 2018;73:1131-1134. DOI: 10.1111/all.13366.Kennedy JL, Stallings AP, Platts-Mills TA, Oliveira WM, Workman L, James HR et al. Galactose-alpha-1,3-galac-tose and delayed anaphylaxis, angioedema, and urticaria in children. Pediatrics. 2013;131:1545-1552. DOI: 10.1542/ peds.2012-2585Sandhu M, Casselman J, Peppers B, Tcheurekdjian H, Hostoffer RW Type 1 Kounis syndrome in a patient with idiopathic anaphylaxis. Allergy Rhinol. 2017:8;103-104. DOI: 10.2500/ ar.2017.8.0198.Keber T, Makuc J, Sekavcnik G. Type 1 Kounis Syndrome in Patient with Idiopathic Anaphylaxis. Case Rep Cardiol. 2017;2017:1089023. DOI: 10.1155/2017/1089023.Patterson R, Schatz M, Harton M. Munchausen’s stridor: non-organic laryngeal obstruction. Clin Allergy. 1974;4:307-310.Hendrix S, Sale S, Zeiss CR, Utley J, Patterson R. Factitious Hymenoptera allergic emergency: a report of a new variant of Munchausen’s syndrome. J Allergy Clin Immunol. 1981;67:8-13.Lieberman P, Nicklas RA, Oppenheimer J, Kemp SF, Lang DM, Bernstein DI et al. The diagnosis and management of anaphylaxis practicparameter: 2010 Update. J Allergy Clin Immunol. 2010;126:477-480. DOI: 10.1016/j.jaci.2010.06.022.Simons FER, Arduso LRF, Biló MB, El-Gamal Y, Ledford DK, Ring J et al. World Allergy Organisation guidelines for the assessment and management of anaphylaxis. WAO Journal. 2011;4:13-37. DOI: 10.1097/WOX.0b013e318211496c.Wiggins CA, Dykewicz MS, Patterson R. Corticosteroid-dependent idiopathic anaphylaxis: a report of five cases. J Allergy Clin Immunol. 1989;84:311-315.Lieberman PL. Idiopathic anaphylaxis. Allergy Asthma Proc. 2014;35:17-23. DOI: 10.2500/aap.2014.35.3717.Wong S, Yarnold PR, Yango C, Patterson R, Harris KE. Outcome of prophylactic therapy for idiopathic anaphylaxis. Ann Intern Med. 1991;114:133-136.Khan DA, Yocum MW Clinical course of idiopathic anaphylaxis. Ann Allergy. 1994;73:370-374.Dykewicz MS, Wong SS, Patterson R, Harris KE. Evaluation of ketotifen in corticosteroid-dependent idiopathic anaphylaxis. Ann Allergy. 1990;65:406-410.Warrier P, Casale TB. Omalizumab in idiopathic anaphylaxis. Ann Allergy Asthma Immunol. 2009;102:257-258. DoI: 10.1016/S1081-1206(10)60091-9.Jones JD, Marney SR, Fahrenholz JM. Idiopathic anaphylaxis successfully treated with omalizumab. Ann Allergy Asthma Immunol. 2008:550-551. DOI: 10.1016/S1081-1206(10)60296-7.Demirtürk M, Gelincik A, Çolakoglu B, Dal M, Büyüköztürk S. Promising option in the prevention of idiopathic anaphylaxis: omalizumab. J Dermatol. 2012;39:552-554. DOI: 10.1111/j.1346-8138.2012.01520.x.