全身性嚴重過敏反應 (anaphylaxis) 是一種急性、全身性的過敏反應，主要症狀 為皮膚及黏膜組織異常情形（如蕁麻疹）、呼吸道症狀（如呼吸困難）、低血壓及腸 胃道症狀（如嚴重腹痛），可能在接觸過敏原後數分鐘至幾個小時內即發生，若未能 及時正確處置，可能有致命風險。Epinephrine 為目前國際指引推薦之治療首選藥品，一旦懷疑全身性嚴重過敏反應，須立即以肌肉注射方式施打，研究證實可有效降低死 亡率及住院率。然而過去的研究也發現，由於部分醫療人員對 epinephrine 使用時機 有所疑慮，且擔憂其副作用，因此指引與臨床實務作業仍有落差，甚至仍將類固醇或 抗組織胺視為第一線用藥。醫院內導入臨床路徑或建置作業流程已被證實可有效提升 全身性嚴重過敏反應治療指引遵從性，藥師可在提升治療品質方面扮演重要角色。

 

Anaphylaxis is an acute, systematic hypersensitivity reaction, mainly involving the skin and mucosal tissue (e.g., urticaria), respiratory tract (e.g., dyspnea), gastrointestinal tract (e.g., crampy abdominal pain), and hypotension. Symptoms of anaphylaxis can occur immediately within minutes to hours after exposure to the allergen, and lead to death. Epinephrine is recommended as the first choice of treatment by guidance and should be administrated through intramuscular route as soon as possible. Epinephrine has been confirmed to reduce hospitalization and mortality rate. However, owing to the consideration of administration timing of epinephrine and cardiovascular adverse reactions, there is a gap between guidelines and clinical practice. Implementation of clinical pathway or protocol have been proved to improve the use of epinephrine in anaphylaxis management, and pharmacists could play an important role in improving quality of management.

 

Submited for publication: 2021.7.13; Accepted for publication: 2021.10.26