벌독 아나필락시스 후에 발생한 허혈성 대장염 1예

김성훈,한군희,박종규,이상진,김영돈,정우진,강길현,천갑진 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.3

Anaphylaxis is a potentially life-threatening allergic reaction, presenting with various clinical symptoms. The most common etiologies of anaphylactic reactions include allergic responses to food, medications, latex, and Hymenoptera stings. In its classic form, anaphylaxis typically involves the cutaneous, respiratory and cardiovascular systems. Gastrointestinal symptoms, including nausea, vomiting, diarrhea and cramping abdominal pain, can occur transiently but mucosal lesions are rarely detected. We recently experienced a case of ischemic colitis presenting with hematochezia after bee venom-induced anaphylactic shock. To the best of our knowledge, this is the first case in Korea. We report the case with a review of the literature. 아나필락시스는 주로 제1형 즉시형 과민반응을 통해 일어나며 피부 발진, 두드러기, 설사 등의 가벼운 증상부터 호흡곤란, 저혈압, 부정맥 등의 생명을 위협하는 전신 증상까지 나타날 수 있는 급성 반응이다. 그러나 각각의 임상 증상을 보이는 병태생리 기전은 정확히 알려져 있지 않으며 특히 벌독에 의한 아나필락시스 후에 발생한 허혈성 대장염에 대한 국내외 보고는 없었다. 저자들은 벌독에 의한 아나필락시스 후에 발생한 혈변으로 내원한 허혈성 대장염 환자 1예를 경험하여서 문헌고찰과 함께 보고한다.

체외순환 후 Protamine에 의해 유발된 아나필락시스 반응 -1예 보고-

백종현,이동협,한승세,이정철,정태은,이장훈 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.7

Anaphylactic reaction to protamine sulfate, which is used widely to reverse the anticoagulative effect of heparin after cardiopulmonary bypass, is very rare. But the result of anaphylactic reaction can be very fatal and the mechanism of it is still not clear. We report a case of severe anaphylactic reaction to protamine sulfate following the replacement of the mitral valve and Maze procedure using microwave in a non-diabetic 57-year-old female patient. 체외순환 후 heparin의 항응고효과를 중화시키기 위해 널리 사용되는 protamine에 대한 아나필락시스반응은 매우 드물다. 하지만 그 결과는 매우 치명적일 수 있으며, 아직도 정확한 발생기전이 알려져 있지 않다. 당뇨병이 없는 57세 여자 환자가 승모판막 치환술 및 극초단파(Microwave)를 이용한 Maze 술식을 시행받은 후 protamine에 의한 심각한 아나필락시스 반응이 발생하여 증례 보고하는 바이다.

2020년 주요 의료판결 분석

박노민,정혜승,박태신,유현정,이정민,조우선 대한의료법학회 2021 의료법학 Vol.22 No.2

2020년에 선고된 주요 판결들 중에는, 독감 및 코로나 백신 접종 부작용으로 시의성이 있는 아나필락시스와 관련하여 의료진의 과실을 인정한 사례와 부정한 사례가 있었고, 기존에도 판례를 통해 인정된 적은 있지만 드문 사례로서 수인한도를 넘어설 만큼 불성실하게 진료를 한 경우 그러한 과실을 별도의 불법행위로 인정하여 위자료 지급을 인정한 판결이 선고되었다. 또한, 손해배상 범위 산정과 관련하여, 맥브라이드를 기준으로 노동능력상실률을 산정해온 관행을 깨고 항소심에서 대한의학회 장애평가기준에 따라 장해율을 산정한 판결이 있었으며, 전화 진료를 비롯한 원격의료는 의료법상 허용되지 않는다는 대법원의 입장을 명확히 하였다는 점에서 의미 있는 판결이 있었다. 설명의무에 관하여는 확립된 법리 위에 개별 사건에서 설명의무 이행 여부를 판단하는 구체적 기준에 관한 세부적인 내용이 더해지는 과정으로 보이며, 진료기록 기재와 관련하여서는 사후기재의 의심이 강하게 들더라도 증명방해에 해당하지 않는다고 판단하였다. 그 외에도, 사실관계가 동일함에도 심급에 따라 과실 및 인과관계 판단이 달라진 판결들에서 원심판결과 대상판결의 차이점을 비교하였으며, 최근 의사의 업무상과실치사상에 대하여 실형이 선고되는 사례가 늘고 있는 상황에서 1심에서 실형을 선고하면서 구체적으로 그 이유에 관하여 설명한 판결을 다루었다. Among the major rulings handed down in 2020, there were cases involving anaphylaxis, which is timely as a side effect of coronavirus and flu vaccine. And as a rare case, a ruling was handed down that if medical treatment was done so unfaithfully beyond the limit of patience of ordinary people, it can be an independent illegal act and a cause of compensation for emotional distress. Also, there was a ruling in the appellate court that evaluated disability rate applying the Korean Academy of Medical Sciences Guides for the Evaluation of Permanent Impairment, not McBride system. And the supreme court made it clear that telemedicine is illegitimate. In relation to duty of explanation, it is in the process of adding detail criterion on the firm principles in the individual cases. In regard of medical records, there was a case that even when a medical record is strongly suspected to be tampered with, it is not considered to be an obstruction of proof. There were cases that resulted in different conclusion between the court of first instance and the appellate court rulings. Lastly, in the face of a growing number of cases in which doctors are sentenced to prison for malpractice, we reviewed a ruling that sentenced a doctor to prison.

Omalizumab 투여로 호전된 반복적 아나필락시스를 보인 전신 비만세포증 1예

문홍란,장희준,이춘근,김영찬,유신혜,이동순,강혜련 대한내과학회 2018 대한내과학회지 Vol.93 No.1

Mastocytosis is a disorder characterized by abnormal mast cell proliferation and accumulation in one or more tissues. It presents in two major variants: cutaneous mastocytosis and systemic mastocytosis. Because the symptoms are related to mast cells, histamine receptor antagonists and leukotriene receptor antagonists are recommended as therapeutic options. Here, we report a 54-year-old male patient with a history of urticaria pigmentosa who presented with recurrent anaphylaxis. His serum tryptase level was 31.7 ng/mL and mast cell infiltration was observed in his bone marrow. He had frequent attacks of anaphylaxis despite treatment with ketotifen, levocetirizine, and montelukast. Symptoms related to systemic mastocytosis were controlled and the patient exhibited no recurrence of anaphylaxis following the introduction of monthly omalizumab injection. Omalizumab can be considered as a treatment option in patients with systemic mastocytosis unresponsive to conventional oral medications. 저자들은 빈번한 아나필락시스를 보이는 환자에서 비활동성 비만세포증을 확진하였으며, omalizumab으로 효과적으로 치료하였기에 문헌고찰과 함께 보고하는 바이다.

Tryptophan Negatively Regulates IgE-mediated Mast Cell Activation

Prashanta Silwal(실왈 프라산타),Keuna Shin(신근아),Seulgi Choi(최슬기),Uk Namgung(남궁욱),Chan Yong Lee(이찬용),Jun-Young Heo(허준영),Kyu Lim(임규),Jong IL Park(박종일),Ki-Hwan Kim(김기환),Seung-Kiel Park(박승길) 대한체질인류학회 2017 해부·생물인류학 (Anat Biol Anthropol) Vol.30 No.2

비만세포는 알레르기 반응을 일으키는 주된 세포로서 항원 자극에 반응하여 알레르기 유발 물질인 히스타민, 단백질 분해효소, 염증성 지질 물질 및 사이토카인 등을 분비한다. 아미노산인 트립토판은 염증반응을 조절한다. 트립토판 투여는 비만세포가 관여하는 염증성 장염 증상을 완화시킨다. 그러나 트립토판이 비만세포의 알레르기 반응에 미치는 영향에 대한 연구는 없다. 본 저자들은 트립토판이 IgE 매개 알레르기 반응에 미치는 영향을 비만세포 수준에서 그리고 실험동물 생쥐에서 연구하였다. IgE-매개 수동 피부 아나필락시스를 생쥐에서 연구하였다. 또한 IgE-매개 비만세포 활성화 반응 즉, 탈과립 반응, 염증성 지질인 LTB4와 사토카인 (TNF-α와 IL-4) 등의 분비를 측정하였다. 트립토판을 생쥐에 복강 주사하면 IgE 매개 수동 피부 아나필락시스를 억제하였다. 또한 비만세포 수준에서도 트립토판은 IgE 매개 알레르기 반응들, 즉 탈과립 반응과 염증성 지질인 LTB4 및 사이토카인인 TNF-α와 IL4의 분비를 억제하였다. 이러한 결과로부터 트립토판은 IgE 매개 알레르기 반응을 세포 수준 및 실험동물 수준에서 억제함을 알 수 있었다. Mast cells are major immune cells in allergy to secrete allergic mediators by a degranulation process and make and secrete inflammatory lipids and cytokines in response to antigen stimulation. An amino acid tryptophan regulates immune functions. Tryptophan ameliorates inflammatory colitis in which mast cells are engaged. However, its effects on mast cells remain to be solved. We investigated the effect of tryptophan on IgE-mediated allergic responses in the mast cells and mice. IgEmediated passive cutaneous anaphylaxis (PCA) in mice were examined. Also IgE-mediated mast cell activation responses such as degranulation of stored granules and secretion of inflammatory lipid LTB4 and cytokines (TNF-α and IL-4) were measured. Intraperitoneal administration of tryptophan suppressed PCA in mice. Also, in the cellular level tryptophan inhibited IgE-mediated mast cell activation such as IgE-mediated degranulation and the production of LTB4. Also, it inhibited production of inflammatory cytokines TNF-α and IL-4. In summary, tryptophan suppressed IgE-mediated allergic activation in vivo and in vitro. Tryptophan supplementation is beneficial for IgE-mediated allergy.

의학강좌 : 아나필락시스의 관리

남영희 ( Young Hee Nam ),이수걸 ( Soo Keol Lee ) 대한내과학회 2015 대한내과학회지 Vol.89 No.4

Anaphylaxis is a life-threatening systemic hypersensitivity reaction with a rapid onset. All healthcare professionals should be familiar with its recognition and management. The clinical diagnosis is important. It involves the sudden onset of characteristic symptoms and signs within minutes to hours after exposure to a known or potential trigger, often followed by rapid progression over hours. Symptoms usually involve two or more body systems, including the skin and mucous membranes, and respiratory, gastrointestinal, cardiovascular, and central nervous systems. Prompt initial basic treatment with intramuscular epinephrine in the mid-anterolateral thigh can be life-saving. Simultaneously, it is important to place the patient in a supine position, call for help when indicated, provide supplemental oxygen, start intravenous fluid, and provide cardiopulmonary resuscitation as required, while monitoring the patient’s vital signs and oxygenation status. Antihistamines and glucocorticoids are not initial treatments of choice. For self-management, patients at risk of anaphylaxis should carry epinephrine auto-injectors, have personalized emergency action plans, and follow-up with a physician about preventing anaphylaxis recurrence. Patient and caregiver training and education are essential in the management of anaphylaxis. (Korean J Med 2015;89:413-417)

아나필락시스의 진단과 응급처치

정재원 대한의사협회 2014 대한의사협회지 Vol.57 No.11

Anaphylaxis is a severe systemic allergic reaction with a rapid onset that is potentially fatal. The incidence of anaphylaxisis increasing. The diagnosis of anaphylaxis is based primarily on a detailed history-taking of the episode, includinginformation about all exposures and events in the hours preceding the onset of symptoms. Target organ involvementis variable. In general, symptoms occur in 2 or more body systems: the skin and mucous membranes, upper and lowerrespiratory tract, gastrointestinal tract, cardiovascular system, and central nervous system. Epinephrine is the primarymedical therapy, and it must be administered promptly. Intramuscular injection of epinephrine into the antero-lateralthigh is the preferred injection route in an urgent situation. Prevention of recurrence depends primarily on optimalmanagement of patient-related risk factors, plus strict avoidance of the causative allergen or other triggers. Whenindicated, the practitioner should prescribe self-injectable epinephrine and should educate the patient on how to use it.

벌독 아나필락시스쇼크 후 병발한 신부전과 스트레스성 심근병증

천미주 ( Mi Ju Cheon ),윤병우 ( Byung Woo Yoon ),송용건 ( Yong Geon Song ),이창균 ( Chang Kyun Lee ),이태연 ( Tae Yeon Lee ),조인수 ( In Soo Cho ),홍지연 ( Ji Yeon Hong ) 대한내과학회 2016 대한내과학회지 Vol.90 No.5

Bee venom-induced anaphylaxis usually causes urticaria, angioedema, respiratory distress, nausea, and vomiting. Occasionally, it leads to unusual complications such as acute myocardial infarction, takotsubo cardiomyopathy, arrhythmia, rhabdomyolysis, intravascular hemolysis, and acute kidney injury. Renal complications are rare, and there are only two cases of acute kidney injury associated with rhabdomyolysis due to multiple bee stings reported in Korea. We report a 67-year-old woman who presented at our emergency department with confusion, respiratory distress, and dizziness after multiple bee stings. She was diagnosed with anaphylactic shock. There was acute kidney injury associated with rhabdomyolysis and heart failure related to takotsubo cardiomyopathy, all of which indicated unusual and fatal complications. Her condition worsened, almost requiring intubation and mechanical ventilation. However, the patient recovered without cardiac or renal complications within 30 days of therapy with hydration and diuretics. (Korean J Med 2016;90:427-432)

Oxaliplatin에 대한 아나필락시스반응 1예

김종대 ( Jong Dai Kim ),이정호 ( Jeong Ho Lee ),박현웅 ( Hyun Woong Park ),김기홍 ( Ki Hong Kim ),강미일 ( Mi Il Kang ),조도연 ( Do Yeun Cho ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

컴퓨터 단층촬영에 사용되는 조영제의 부작용 발생에 대한 분석

권기수,정재심 대한기초간호자연과학회 2004 Journal of korean biological nursing science Vol.6 No.2

The contrast medium is very commonly used in more than 90% of computed tomography(CT) scans. It is difficult to predict the occurrence of adverse reactions and the degree of adverse reactions are diverse from mild urticaria, itching, nausea, vomiting to even cardiopulmonary arrest. The purpose of this study was to evaluate the symptoms, occurrence rate and risk factors of the adverse reactions in patients after contrast injection during CT examinations. Two hundreds sixty-five patients showed symptoms of adverse reactions out of 71,117 adult patients who received intravenous contrast administration during CT scans from January 2003 to December 2003 at a general hospital. Data was collected by reviewing adverse reaction records and electronic medical record. The results of this study were as follows; 1. Adverse reactions occurred in 265 out of a total of 71,117 patients(0.37%). Clinical symptoms of adverse reactions were most commonly dermatologic problems such as urticaria(69.81%) and itching (63.02%), followed by dyspnea(14.34%), dizziness(11.70%), nausea(6.79%), and vomiting(7.17%). 2. Anaphylactoid reactions occurred in 47 out of a total of 265 patients, and their pattern of symptoms were most commonly related to cardiovascular system(90.91%), followed by respiratory system(82.22%), gastrointestinal system(51.72%), and dermatologic system(16.51%). Eleven patients were transferred to emergency room for further treatment and two patients needed cardiopulmonary resuscitation. 3. The adverse reactions were significantly more common in women than in men (0.46% vs.0.32%, p= .003) and in type D contrast medium than the others(p<.001). The occurrence rate of adverse reactions was not significantly different according to the age and infusion speed of the contrast medium.