精品医学文献翻译中英对照.docx

精品医学文献翻译中英对照.docx

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精品医学文献翻译中英对照

医学文献翻译（中英对照）

Theclinicalandcost-effectivenessofPharmalgen®forthetreatmentofbeeandwaspvenomallergy

1TITLEOFPROJECT

TheclinicalandcosteffectivenessofPharmalgen®forthetreatmentofbeeandwaspvenomallergy

2TARTEAM

LiverpoolReviewsandImplementationGroup（LRiG）,UniversityofLiverpool

Correspondenceto:

RumonaDickson,Ms

Director,LRiG

UniversityofLiverpool

Room2.12

WhelanBuilding

TheQuadrangle

BrownlowHill

Liverpool

L693GB

Tel:

+44（0）1517945682

Fax:

+44（0）1517945585

Email:

R.Dickson@liv.ac.uk

FordetailsofexpertisewithintheTARteam,seesection7.

3PLAINENGLISHSUMMARY

Allergicreactionstobeeandwaspvenommayoccurinvenom-sensitivepatientsimmediatelyfollowingasting,andcanvaryinseverity,withinitiallymildsymptomssometimesprogressingtocriticalconditionswithinseconds.Themostseveresystemicallergicreactions（generalisedreactions）areknownasanaphylaxis,areactioncharacterisedbyabnormallylowbloodpressure,faintingorcollapse,andinextremereactionsthesesymptomscancausedeath.

EachyearintheUKtherearebetweentwoandninedeathsfromanaphylaxiscausedbybeeandwaspvenom.Theimmediatetreatmentforsevereallergicreactionstobeeandwaspvenomconsistsofemergencytreatmentwithdrugstodecreasethepatient’sresponsetothevenomandsupportbreathing,ifrequired.

Toavoidfurtherreactions,theuseofsensitisationtobeeandwaspvenom,throughaprocessknownasvenomimmunotherapy（VIT）,hasbeeninvestigated.Venomimmunotherapyconsistsofsubcutaneousinjectionsofincreasingamountsofvenomintopatientswithahistoryofanaphylaxistobeeandwaspvenom.Pharmalgen®hashadUKmarketingauthorisationforthediagnosisandtreatment（usingVIT）ofallergytobeevenom（usingPharmalgen®BeeVenom）andwaspvenom（usingPharmalgen®WaspVenom）sinceMarch1995,anditisusedbymorethan40centresacrosstheUK.ThisreviewaimstoassesswhetherusingPharmalgen®inVITisclinicallyusefulwhentreatingpeoplewithahistoryofseverereactiontobeeandwaspstings.ThereviewwillcomparepreventativetreatmentwithPharmalgen®toothertreatmentoptions,includinghighdoseantihistamines,adviceontheavoidanceofbeeandwaspstingsandadrenalineauto-injectorprescriptionandtraining.Ifsuitabledataareavailable,thereviewwillalsoconsiderthecosteffectivenessofusingPharmalgen®forVITandothersubgroupsincludingchildrenandpeopleathighriskoffuturestingsorsevereallergicreactionstofuturestings.

4DECISIONPROBLEM

4.1Clarificationofresearchquestionandscope

Pharmalgen®isusedforthediagnosisandtreatmentofimmunoglobinE（IgE）-mediatedallergytobeeandwaspvenom.TheaimofthisreportistoassesswhethertheuseofPharmalgen®isofclinicalvaluewhenprovidingVITtoindividualswithahistoryofseverereactiontobeeandwaspvenomandwhetherdoingsowouldbeconsideredcosteffectivecomparedwithalternativetreatmentoptionsavailableintheNHS.

4.2Background

BeesandwaspsformpartoftheorderHymenoptera（whichalsoincludesants）,andwithinthisorderthespeciesthatcausethemostfrequentallergicreactionsaretheVespidae（wasps,yellowjacketsandhornets）,andtheApinae（honeybees）.1

Beeandwaspstingscontainallergenicproteins.Inwasps,thesearepredominantlyphospholipaseA1,2hyaluronidase2andantigen5,3andinbeesarephospholipaseA2andhyaluronidase.4Followinganinitialsting,atype1hypersensitivityreactionmayoccurinsomeindividualswhichproducestheIgEantibody.Thissensitisescellstotheallergen,andanysubsequentexposuretotheallergenmaycausetheallergentobindtotheIgEmolecules,whichresultsinanallergicreaction.

Theseallergenstypicallyproduceanintense,burningpainfollowedbyerythema（redness）andasmallareaofoedema（swelling）atthesiteofthesting.Thesymptomsproducedfollowingastingcanbeclassifiedintonon-allergicreactions,suchaslocalreactions,andallergicreactions,suchasextensivelocalreactions,anaphylacticsystemicreactionsanddelayedsystemicreactions.5-6Systemicallergicreactionsmayoccurinvenom-sensitivepatientsimmediatelyfollowingasting,7andcanvaryinseverity,withinitiallymildsymptomssometimesprogressingtocriticalconditionswithinseconds.1

Themostseveresystemicallergicreactionisknownasanaphylaxis.Anaphylacticreactionsareofrapidonset（typicallyupto15minutespoststing）andcanmanifestindifferentways.Initialsymptomsareusuallycutaneousfollowedbyhypotension,withlight-headedness,faintingorcollapse.Somepeopledeveloprespiratorysymptomsduetoanasthma-likeresponseorlaryngealoedema.Inseverereactions,hypotension,circulatorydisturbances,andbreathingdifficultycanprogresstofatalcardio-respiratoryarrest.

Anaphylaxisoccursmorecommonlyinmalesandinpeopleunder20yearsofageandcanbesevereandpotentiallyfatal.8

4.3Epidemiology

Itisestimatedthattheprevalenceofwaspandbeestingallergyisbetween0.4%and3.3%.9Theincidenceofsystemicreactionstowaspandbeevenomisnotreliablyknown,butestimatesrangefrom0.15-3.3%,10-11Systemicallergicreactionsarereportedbyupto3%ofadults,andalmost1%ofchildrenhaveamedicalhistoryofseverestingreactions.9,12Afteralargelocalreaction,5–15%ofpeoplewillgoontodevelopasystemicreactionwhennextstung.13Inpeoplewithamildsystemicreaction,theriskofsubsequentsystemicreactionsisthoughttobeabout18%.13HymenopteravenomareoneofthethreemaincausesoffatalanaphylaxisintheUSAandUK.14-15Insectstingsarethesecondmostfrequentcauseofanaphylaxisoutsideofmedicalsettings.16BetweentwoandninepeopleintheUKdieeachyearasaresultofanaphylaxisduetoreactionstowaspandbeestings.17Onceanindividualhasexperiencedananaphylacticreaction,theriskofhavingarecurrentepisodehasbeenestimatedtobebetween60%and79%.13

In2000,theregisteroffatalanaphylacticreactionsintheUKfrom1992onwardswasreportedbyPumphreytodeterminethefrequencyatwhichclassicmanifestationsoffatalanaphylaxisarepresent.18Ofthe56post-mortemscarriedout,19deathswererecordedasreactionstoHymenopteravenom（33.9%）.Aretrospectivestudyin2004examinedalldeathsfromanaphylaxisintheUKbetween1992and2001,andestimated22.19%tobereactionstoHymenopteravenom（47/212）.Thisfurtherbreaksdowninto29/212（13.68%）asreactionstowaspstings,and4/212（1.89%）asreactionstobeestings.Theremaining14/212wereunidentifiedHymenopterastings（6.62%）.19

4.4Currentdiagnosticoptions

Currently,individualscanbetestedtodetermineiftheyareatriskofsystemicreactionstobeeandwaspvenom.Theprimarydiagnosticmethodforsystemicreactionstobeeand/orwaspstingsisvenomskintesting.

SkintestinginvolvesintradermalinjectionwiththefiveHymenopteravenomproteinextracts,withvenomconcentrationsintherangeof0.001to1.0μg/ml.Thisestablishestheminimumconcentrationgivingapositiveresult（areactionoccurringintheindividual）.Asvenomtestsshowunexplainedvariabilityovertime,20andasnegativeskintestscanoccurfollowingrecentanaphylaxis,itisrecommendedthattestsberepeatedafter1to6months.21

Othermethodsofdiagnosisinpatientsfollowingananaphylacticreactionincluderadioallergosorbenttest（RAST）,whichdetectsallergen-specificIgEantibodiesinserum.Thistestislesssensitivethanskintestingbutisusefulwhenskintestscannotbedone,forexampleinpatientswithskinconditions.22-23

4.5Currenttreatmentoptions

Preventativetreatmentsincludeeducationonhowtoavoidbeeandwaspvenom,andprescriptionofhighdoseantihistamines.Patientswithahistoryofmoderatelocalreactionsshouldbeprovidedwithanemergencykit,24containingaH1-blockingantihistamineandatopicalcorticosteroidforimmediateusefollowingasting.Patientswithahistoryofanaphylaxisshouldbeprovidedwithanemergencykitcontainingarapid-actingH1-blockingantihistamine,anoralcorticosteroidandanauto-injectorforselfadministration,containingepinephrine.

Injectedepinephrine（asympathomimeticdrugwhichactsonbothalphaandbetareceptors）isregardedastheemergencytreatmentofchoiceforcasesofacuteanaphylaxisasaresultofHymenopterastings.25Foradults,therecommendeddoseisbetween0.30mg/mland0.50mg/mlI.M,and0.01ml/kgI.M.forchildren.Individualswithahistoryofanaphylacticreactionsarerecommendedtocarryautoinjectorscontainingepinephrine（commonlyknownasEpiPen®,Adrenaclick®,Anapen®orTwinject®）.Theseareintendedforimmediateself-administrationbyindividualswithahistoryofhypersensitivitytoHymenopterastingsandotherallergens.

PreventivemeasuresfollowingsuccessfultreatmentofasystemicallergicreactiontoHymenopteravenomconsistsofeitherallergenavoidanceorspecificallergenimmunotherapy,knownasVIT.Venomimmunotherapyisconsideredtobeasafeandeffectivetreatment.26Currently,VITcanbeusedwithseveralregimes,includingPharmalgen®（manufacturedbyALKAbello,andlicensedintheUK）,Aquagen®andAlutardSQ®（bothmanufacturedbyALKAbelloandunlicensedintheUKbutlicensedinsomepartsofEurope）,VENOMENHAL®（HALAllergy,Leiden,Netherlands,unlicensedintheUK）,Alyostal®（Stallergenes,AntonyCedex,France,unlicensedintheUK）,andVenomil®（Hollister-StierLaboratoriesLLC,unlicensedintheUK）.Venomimmunotherapyisrecommendedtopreventfuturesystemicreactions.ItisrecommendedthatVITisconsidered‘whenpositivetestres