Incidence and characteristics of biphasic anaphylaxis: a prospective evaluation of 103 patients

Ellis, Anne K.; Day, James H.

doi:10.1016/s1081-1206(10)60861-7

Cited by 145 publications

(127 citation statements)

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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Register and websites listing ongoing trials and contacted international experts in anaphylaxis in an attempt to locate unpublished material.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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confidence: 99%

Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review

Choo

Simons

Sheikh

2010

Allergy

145

121

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“…However, many cases have now been described where the onset of biphasic reactivity was considerably beyond 4 to 6 hrs, sometimes exceptionally so. In Brazil and MacNamara's series [19], all but one of the biphasic reactions occurred later than this window (range of 9h-29.5h), and the mean time to onset of the second phase in Ellis and Day's report was 10h overall, with >40% of subjects having an asymptomatic window of more than 10h [20]; the longest interval was 78 hours. Importantly, 13 of the 19 patients who experienced biphasic reactions (68%) developed recurrent symptoms after they had been discharged from the ED.…”

Section: Clinical Characteristics Of Biphasic Anaphylactic Reactionsmentioning

confidence: 84%

“…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]. This study included both anaphylactic events treated in the ED and discharged home as well as those admitted to hospital and those inpatients suffering an in-hospital anaphylactic reaction due to a medication, etc.…”

Section: Epidemiology and Incidence Of Biphasic Anaphylaxismentioning

confidence: 99%

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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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“…Moreover, some reports mentioned treatment differences between patients with uniphasic and biphasic events. These included delay in administration of adrenaline for the primary response, inadequate dose of adrenaline for treatment of the primary reaction, and absence of or too small a dose of corticosteroids given for the initial treatment 47, 49. Therefore, when anaphylactic shock is identified, the patient should be treated with adrenaline and observed for at least 8 h to rule out a biphasic reaction.…”

Section: Biphasic Reactionsmentioning

confidence: 99%

Drug‐induced anaphylaxis in the emergency room

Takazawa

Oshima

Saito

2017

Acute Medicine & Surgery

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Anaphylaxis is a life‐threatening, systemic allergic reaction that presents unique challenges for emergency care practitioners. Anaphylaxis occurs more frequently than previously believed. Therefore, proper knowledge regarding the epidemiology, mechanisms, symptoms, diagnosis, and treatment of anaphylaxis is essential. In particular, the initial treatment strategy, followed by correct diagnosis, in the emergency room is critical for preventing fatal anaphylaxis, although making a diagnosis is not easy because of the broad and often atypical presentation of anaphylaxis. To this end, the clinical criteria proposed by the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network are useful, which, together with a differential diagnosis, could enable a more accurate diagnosis. Additional in vitro tests, such as plasma histamine and tryptase measurements, are also helpful. It should be emphasized that adrenaline is the only drug recommended as first‐line therapy in all published national anaphylaxis guidelines. Most international anaphylaxis guidelines recommend injecting adrenaline by the intramuscular route in the mid‐anterolateral thigh, whereas i.v. adrenaline is an option for patients with severe hypotension or cardiac arrest unresponsive to intramuscular adrenaline and fluid resuscitation. In addition to the route of administration, choosing the appropriate dose of adrenaline is essential, because serious adverse effects can potentially occur after an overdose of adrenaline. Furthermore, to avoid future recurrence of anaphylaxis, providing adrenaline auto‐injectors and making an etiological diagnosis, including confirmation of the offending trigger, are recommended for patients at risk of anaphylaxis before their discharge from the emergency room.

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Incidence and characteristics of biphasic anaphylaxis: a prospective evaluation of 103 patients

Cited by 145 publications

References 13 publications

Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review

Glucocorticoids for the treatment of anaphylaxis: Cochrane systematic review

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

Drug‐induced anaphylaxis in the emergency room

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