Incidence and characteristics of biphasic reactions after allergen immunotherapy

Scranton, Stephen E.; González, E. González; Waibel, Kirk H.

doi:10.1016/j.jaci.2008.10.026

Cited by 78 publications

(57 citation statements)

References 11 publications

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Section: Predictors Of Biphasic Reactivitymentioning

confidence: 93%

“…Scranton et al reported biphasic reactions after immunotherapy-induced anaphylaxis [21] further confirming that the route of antigen delivery need not be oral to experience a biphasic response. Any other potential risk factors/predictors identified throughout the various case series, such as female gender [21], and higher body temperature [17] have only been described in isolated reports and are unlikely to be as robust as the factors summarized above. Additionally, reports of 'protective' factors have been contradicting, with some studies suggesting that the use of corticosteroids may have been protective against biphasic reactivity [13,20] and others not [4,[15][16][17][18][19].…”

Section: Predictors Of Biphasic Reactivitymentioning

confidence: 93%

“…The most recent prospective evaluation of biphasic reactions was in the targeted population of immunotherapy-induced anaphylaxis. Scranton et al prospectively enrolled all subjects experiencing a systemic reaction after immunotherapy injections requiring treatment with epinephrine, and contacted all subjects 24 hours after discharge from clinic to survey their recurrent/ongoing symptomatology, if any [21]. Twenty-three percent (23%) of subjects who experienced systemic reactivity in the clinic after an immunotherapy injection had recurrent symptoms, but not all of these symptoms would normally have been classified as an anaphylactic reaction, per se (e.g.…”

Section: Epidemiology and Incidence Of Biphasic Anaphylaxismentioning

confidence: 99%

“…While not all reports have been able to link severity of the initial presentation directly to an increased risk for biphasic reactivity, several authors have now reported that patients requiring more than one dose of epinephrine and/or higher doses of epinephrine to control symptoms [18,19,21] have an increased risk of a biphasic anaphylactic response. That many authors have described the majority of biphasic responses to be clinically similar to the initial presentation [16,19,20], is in itself, an indication that a more severe initial reaction would be a risk factor for a biphasic response to itself be severe, were it to occur.…”

Section: Predictors Of Biphasic Reactivitymentioning

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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Section: Predictors Of Biphasic Reactivitymentioning

confidence: 93%

Section: Predictors Of Biphasic Reactivitymentioning

confidence: 93%

Section: Epidemiology and Incidence Of Biphasic Anaphylaxismentioning

confidence: 99%

Section: Predictors Of Biphasic Reactivitymentioning

confidence: 99%

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

Ellis¹

2010

TOALLJ

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“…Biphasic reactions are characterized by complete clinical resolution of the initial symptoms, followed by the onset of late‐phase symptoms 46, 47, 48. Although the timing of late‐phase symptom onset after resolution of the initial event ranges from 1 to 78 h, most second responses occur within 8 h after resolution of the primary event 47.…”

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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