[罂粟摘要]福尔可定暴露会增加神经肌肉阻滞剂围手术期过敏反应的风险：ALPHO 病例对照研究

福尔可定暴露会增加神经肌肉阻滞剂围手术期过敏反应的风险：ALPHO 病例对照研究

贵州医科大学      麻醉与心脏电生理课题组

翻译 :  柏雪      编辑 :  严旭       审校 :  曹莹

背景: 神经肌肉阻断剂(NBMAs)是围手术期过敏反应的主要原因之一，其中大多数反应是IgE介导的。环境暴露于其他含季氨化合物(如福尔可定)引起的过敏致敏已被提出。本研究的目的是评估福尔可定暴露与NBMA相关过敏反应之间的关系。

方法：ALPHO 是一项多中心病例对照研究，比较了在法国发生 NMBA 相关围手术期过敏反应的患者（例数）和麻醉顺利的对照患者在麻醉前一年内的福尔可定暴露情况。每个病例根据年龄、性别、NMBA 类型、地理区域和季节相匹配。通过自填问卷和从药房记录中检索的药物史评估福尔可定暴露情况。还评估了抗福尔可定和抗季铵特异性 IgE (sIgE) 的诊断价值。

结果：167个病例与334个对照组匹配。NMBA 相关的过敏反应与福尔可定消耗量（优势比 4.2；95% 置信区间 2.3-7.0）和季铵化合物的职业暴露（优势比 6.1；95% 置信区间 2.7-13.6）显著相关，这表明除了福尔可定外，其他环境因素也可能导致对 NMBA 敏感。福尔可定和季铵盐 sIgE 在识别 NMBA 相关反应方面具有很高的阴性预测值 (99.9%)，但阳性预测值非常低 (<3%)。

结论：在NMBA暴露前12个月接触福尔可定的患者发生NMBA相关过敏反应的风险显著增加。因为福尔可定和季铵 sIgE 的低阳性所以它不用于识别NMBA 相关过敏反应的高风险人群。

原始文献来源 ：  

Paul Michel Mertes, Nadine Petitpain, Charles Tacquard, et, al. Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study. British Journal of Anaesthesia, doi:10.1016/j.bja.2023.02.026

英文原文

Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study

Background: Neuromuscular blocking agents (NMBAs) are among the leading cause of perioperative anaphylaxis, and most of these reactions are IgE mediated. Allergic sensitisation induced by environmental exposure to other quaternary ammonium-containing compounds, such as pholcodine, has been suggested. The aim of this study was to assess the relationship between pholcodine exposure and NMBA-related anaphylaxis.

Methods: ALPHO was a multicentre case-control study, comparing pholcodine exposure within a year before anaesthesia between patients with NMBA-related perioperative anaphylaxis (cases) and control patients with uneventful anaesthesia in France. Each case was matched to two controls by age, sex, type of NMBA, geographic area, and season. Pholcodine exposure was assessed by a self-administered questionnaire and pharmaceutical history retrieved from pharmacy records. The diagnostic values of anti-pholcodine and anti-quaternary ammonium specific IgE (sIgE) were also evaluated.

Results: Overall, 167 cases were matched with 334 controls. NMBA-related anaphylaxis was significantly associated with pholcodine consumption (odds ratio 4.2; 95% confidence interval 2.3-7.0) and occupational exposure to quaternary ammonium compounds (odds ratio 6.1; 95% confidence interval 2.7-13.6), suggesting that apart from pholcodine, other environmental factors can also lead to sensitisation to NMBAs. Pholcodine and quaternary ammonium sIgEs had a high negative predictive value (99.9%) but a very low positive predictive value (<3%) for identifying NMBA-related reactions.

Conclusions: Patients exposed to pholcodine 12 months before NMBA exposure have a significantly higher risk of an NMBA-related anaphylaxis. The low positive predictive values of pholcodine and quaternary ammonium sIgEs precludes their use to identify a population with a high risk of NMBA-related anaphylaxis.

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