CAJ | 학술논문

目的：自2009年起，澳大利亚、美国和欧洲相继报道了一种新型食物过敏病例，患者在进食红肉3～6 h后发生严重过敏反应，这种疾病被认为和蜱叮咬及非灵长类哺乳动物阿尔法半乳糖IgE抗体相关。病例散发于各大洲，本文为我国首次报道。方法对2例进食红肉后迟发严重过敏反应患者的临床表现进行总结并进行蜱叮咬问卷调查。病例1血清和健康对照血清分别与哺乳动物肉和内脏进行免疫印迹实验，观察其特异性结合特点。结果病例1为57岁女性，病例2为44岁男性，均为北京郊县农民。2例患者均在进食红肉后3～6 h多次发生严重过敏反应。患者血清多种哺乳动物蛋白皮肤试验和IgE抗体均为阳性，且阿尔法半乳糖特异性IgE均为阳性（分别为6级＞100 kU/L和3级6．00 kU/L）。病例1在发病前有蜱叮咬史，捕获其家犬身上蜱，经鉴定为长角血蜱。病例2在发作前无明确蜱叮咬病史。血清免疫印迹实验结果提示病例1血清IgE与动物肌肉组织和内脏组织均有特异性结合，其中动物内脏阿尔法半乳糖表型表达高于肌肉组织。结论红肉过敏可导致严重临床症状，威胁患者生命。这一疾病可由蜱叮咬引起，值得公众及临床医生关注。确诊为红肉过敏的患者应避免进食相关肉类和内脏等组织。
목적：자2009년기，오대리아、미국화구주상계보도료일충신형식물과민병례，환자재진식홍육3～6 h후발생엄중과민반응，저충질병피인위화비정교급비령장류포유동물아이법반유당IgE항체상관。병례산발우각대주，본문위아국수차보도。방법대2례진식홍육후지발엄중과민반응환자적림상표현진행총결병진행비정교문권조사。병례1혈청화건강대조혈청분별여포유동물육화내장진행면역인적실험，관찰기특이성결합특점。결과병례1위57세녀성，병례2위44세남성，균위북경교현농민。2례환자균재진식홍육후3～6 h다차발생엄중과민반응。환자혈청다충포유동물단백피부시험화IgE항체균위양성，차아이법반유당특이성IgE균위양성（분별위6급＞100 kU/L화3급6．00 kU/L）。병례1재발병전유비정교사，포획기가견신상비，경감정위장각혈비。병례2재발작전무명학비정교병사。혈청면역인적실험결과제시병례1혈청IgE여동물기육조직화내장조직균유특이성결합，기중동물내장아이법반유당표형표체고우기육조직。결론홍육과민가도치엄중림상증상，위협환자생명。저일질병가유비정교인기，치득공음급림상의생관주。학진위홍육과민적환자응피면진식상관육류화내장등조직。
Objective Anoveldelayedanaphylacticreactiontoredmeat,associatedwithtickbitesandIgE antibodies against galactose-α-1 ,3-galactose (α-gal),was reported in Australia,US,and Europe since 2009.ThisisthefirstclinicalcasestudyofredmeatinduceddelayedanaphylaxisinChina.Method Two cases of delayed anaphylactic reactions to red meat were reported for the first time in China. Clinical manifestations were summarized,allergens were investigated,and questionnaire about tick bite was taken as well. Analysis of the antigen-binding characteristics of serum specific IgE antibodies with pork,innards were performed,based on western blotting by using sera from case 1 and a healthy control to observe the features ofspecificbindingcharacteristics.Results Thetwocases(case1female/57yrs,case2male/44yrs)are both farmers who live in the suburb of Beijing,manifested with anaphylactic reactions three to six hours after red meat ingestion. Serum specific IgE and skin test results to multiple mammalian proteins were positive. Specific IgE to galactose-α-1 ,3-galactose were positive in the two patients (>100 kU/L in case 1 and 6. 00 kU/L in case 2 ).Case 1 reported a history of tick biting with large regional reactions 2-3 weeks before anaphylaxis. The ticks on her dog were captured and authenticated as hematophagous ixodidae. Case 2 did not report history of tick bites. The increased concentration of IgE reactive epitopes in mammalian organs wasconfirmedbyusingwesternblottingwithserumofcase1.Conclusions Ingestionofredmeatcan induce severe and sometimes life-threatening clinical manifestations,which might be induced by tick bite. This issue should arouse concerns both in public and doctors. Patients with red meat allergy should avoid intake of meat as well as innards of non-primate mammalian.