Biphasic and protracted anaphylaxis

Stark, Barbara; Sullivan, Timothy J.

doi:10.1016/0091-6749(86)90117-x

Cited by 317 publications

(183 citation statements)

References 25 publications

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“…The occurrence of biphasic reactions has been established in the literature and appears to occur in 1% to 20% of anaphylactic reactions (as depicted in Table II). 8,11,27,[29][30][31][32][33][34] In a study evaluating patients with fatal or near-fatal food reactions, approximately 20% of patients experienced a biphasic reaction, indicating that biphasic reactions might be more likely in patients who present initially with severe symptoms. 11 The reported time intervals between the initial reaction Adapted from Smit et al 8 and the onset of the second phase ranged from 1 to 72 hours.…”

Section: Observationmentioning

confidence: 99%

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Sampson

Muñoz-Furlong²,

Campbell

et al. 2006

Journal of Allergy and Clinical Immunology

1,909

1,114

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Section: Observationmentioning

confidence: 99%

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Sampson

Muñoz-Furlong²,

Campbell

et al. 2006

Journal of Allergy and Clinical Immunology

1,909

1,114

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“…There is published evidence that they might be ineffective in this regard (30)(31)(32)(33). The existing evidence for the use of glucocorticoids appears to consist mainly of retrospective studies, case reports, and other descriptive literature.…”

mentioning

confidence: 99%

Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review

Choo

Simons

Sheikh

2010

Allergy

145

121

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To cite this article: Choo KJL, Simons E, Sheikh A. Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review. Allergy 2010; 65: 1205–1211.AbstractBackground: Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may result in death. A number of guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis.Objectives: We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis.Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 3), MEDLINE (Ovid) (1966 to September 2009), EMBASE (Ovid) (1988 to September 2009), CINAHL (EBSCOhost) (to September 2009) and The Science Citation Index Expanded (SCI‐EXPANDED) (1945 to September 2009). We also searched the UK National Research Register and websites listing ongoing trials and contacted international experts in anaphylaxis in an attempt to locate unpublished material. We sought to include randomized and quasi‐randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline (epinephrine), an antihistamine, or any combination of these). Two authors independently assessed articles for inclusion.Results: None of the 2496 reports identified satisfied the inclusion criteria.Conclusions: We conclude that there is no evidence from high‐quality studies for the use of steroids in the emergency management of anaphylaxis. Therefore, we can neither support nor refute the use of these drugs for this purpose.

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“…when subjects with anaphylaxis are followed carefully forward in time after their first wave of reactivity, higher incidence rates are reported. The first such analyses came from Stark and Sullivan in 1986, who documented a 20% overall rate of biphasic responses in a cohort of 25 patients identified prospectively from ED visits and hospitalizations [4]. The next such similarly designed study was not published until 20 years later by Ellis and Day, whose prospective series of all anaphylactic responses occurring in a single tertiary care centre in Canada documented an incidence rate of 19.4% in all-comers with anaphylaxis [20].…”

Section: Epidemiology and Incidence Of Biphasic Anaphylaxismentioning

confidence: 99%

“…generalized itching, malaise). Conversely, both the Stark and Sullivan [4] and the Ellis and Day [20] studies required a minimum of 2 organ systems to be involved in order to be classified as a 'biphasic anaphylactic response'.…”

Section: Epidemiology and Incidence Of Biphasic Anaphylaxismentioning

confidence: 99%

“…Variants of the usual monophasic anaphylaxis syndrome include late onset anaphylaxis, biphasic anaphylaxis, and protracted anaphylaxis [4]. While biphasic reactions are a recognized complication, many updated reviews on the topic of anaphylaxis fail to mention the potential for a second phase of reactivity [5][6][7], or significantly downplay the possibility [8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Biphasic Anaphylaxis: A Review of the Incidence, Characteristics and Predictors

Ellis¹

2010

TOALLJ

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While it has been recognized for over a quarter century that anaphylactic reactions have the potential to follow a biphasic course, reports on the incidence of biphasic anaphylaxis are conflicting, and the search for reliable predictive factors of such responses has been challenging. Further adding to the complexity of this clinical entity are the widely variable durations of the asymptomatic window, and the similarly variable reports on second phase severity. This review aims to provide the health care professional with a better understanding of the true incidence, nature, and risk factors for this type of reactivity by consolidating and summarizing the available literature on the topic of biphasic anaphylaxis. As our body of evidence builds, patterns are emerging to suggest that those patients with an initial presentation requiring more than one dose of epinephrine, those who have life-threatening initial presenting features, and those who otherwise take longer to stabilize, are in this higher risk group, and would be more likely to benefit from prolonged in hospital observation. Conversely, patients who respond rapidly to the immediate administration of epinephrine may be at lower risk, but this finding requires confirmation by others. Further prospective evaluations of biphasic anaphylaxis will greatly aid our understanding of this condition.

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Biphasic and protracted anaphylaxis

Cited by 317 publications

References 25 publications

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review

Biphasic Anaphylaxis: A Review of the Incidence, Characteristics and Predictors

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