Update on biphasic anaphylaxis

Current Opinion in Allergy and Clinical Immunology - Tập 16 Số 4 - Trang 346-351 - 2016
Sangil Lee1,2, Annie T. Sadosty3, Ronna L. Campbell3
1Department of Emergency Medicine, Mayo Clinic Health System, Mankato
2to Sangil Lee, MD, MS, 1025 Marsh Street, Mankato, MN 56001, USA. Tel: +1 507 625 4031
3Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA

Tóm tắt

Purpose of review Biphasic anaphylaxis is a well documented complication of anaphylaxis, but it has been inconsistently defined in the literature. Analysis of contemporary studies of biphasic anaphylaxis based on modern definitions is needed. Recent findings The rate of biphasic reactions in contemporary literature ranges from 0.4 to 14.7% depending on the study population. Observational studies have reported risk factors associated with the development of biphasic reactions; however, findings have been inconsistent and of questionable generalizability. Although life-threatening biphasic reactions are rare, up to 50% of biphasic reactions will require treatment with epinephrine. Early epinephrine administration may have a role in prevention of biphasic reactions, but the role of steroids needs further investigation. The optimal duration of observation is yet to be determined. Summary Given the relative rarity of life-threatening biphasic anaphylaxis and the new context of the NIAID/FAAN standardized definition, further research regarding biphasic anaphylaxis is needed to better elucidate the care model for anaphylaxis patients with a focus on: prevention of biphasic reactions; identification of patients at increased risk of a biphasic reaction; determination of appropriate observation strategies for anaphylaxis patients; and patient education and preparation for management of potential biphasic reactions.

Từ khóa


Tài liệu tham khảo

Sampson, 2006, 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, Ann Emerg Med, 47, 373, 10.1016/j.annemergmed.2006.01.018

Alqurashi, 2015, Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis, Ann Allergy Asthma Immunol, 115, 217, 10.1016/j.anai.2015.05.013

Grunau, 2014, Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis, Ann Emerg Med, 63, 736, 10.1016/j.annemergmed.2013.10.017

Grunau, 2015, Emergency department corticosteroid use for allergy or anaphylaxis is not associated with decreased relapses, Ann Emerg Med, 66, 381, 10.1016/j.annemergmed.2015.03.003

Lee, 2014, Predictors of biphasic reactions in the emergency department for patients with anaphylaxis, J Allergy Clin Immunol Pract, 2, 281, 10.1016/j.jaip.2014.01.012

Lee, 2015, Time of onset and predictors of biphasic anaphylactic reactions: a systematic review and meta-analysis, J Allergy Clin Immunol Pract, 3, 408, 10.1016/j.jaip.2014.12.010

Lewis, 2014, BET 2: in children, do steroids prevent biphasic anaphylactic reactions?, Emerg Med J, 31, 510, 10.1136/emermed-2014-203854.2

Sheikh, 2013, Glucocorticosteroids for the treatment and prevention of anaphylaxis, Curr Opin Allergy Clin Immunol, 13, 263, 10.1097/ACI.0b013e32836097f4

Sricharoen, 2015, What clinical factors are associated with biphasic anaphylaxis in Thai adult patients?, Asian Pac J Allergy Immunol, 33, 8

Rohacek, 2014, Biphasic anaphylactic reactions: occurrence and mortality, Allergy, 69, 791, 10.1111/all.12404

Ko, 2015, Biphasic reactions in patients with anaphylaxis treated with corticosteroids, Ann Allergy Asthma Immunol, 115, 312, 10.1016/j.anai.2015.07.015

Lima, 2015, Anaphylaxis in the emergency room in the city of Sao Paulo: Do we know how to manage?, World Allergy Organ J, 8, A129, 10.1186/1939-4551-8-S1-A129

Jyothi, 2014, PD30-Management of pediatric anaphylaxis-comparison between a district general hospital (DGH) and a regional centre in UK, Clin Transl Allergy, 4, 52, 10.1186/2045-7022-4-S1-P30

Hobbins, 2014, A study of patient knowledge regarding anaphylaxis and the use of epinephrine autoinjector devices, Allergy: European Journal of Allergy and Clinical Immunology, 69, 288

Stark, 1986, Biphasic and protracted anaphylaxis, J Allergy Clin Immunol, 78, 76, 10.1016/0091-6749(86)90117-X

Sampson, 1992, Fatal and near-fatal anaphylactic reactions to food in children and adolescents, New Engl J Med, 327, 380, 10.1056/NEJM199208063270603

Lieberman, 2005, Biphasic anaphylactic reactions, Ann Allergy Asthma Immunol, 95, 217, 10.1016/S1081-1206(10)61217-3

Choo, 2013, Glucocorticoids for the treatment of anaphylaxis, Evid Based Child Health, 8, 1276, 10.1002/ebch.1925

Manivannan, 2014, A multifaceted intervention for patients with anaphylaxis increases epinephrine use in adult emergency department, J Allergy Clin Immunol Pract, 2, 294, 10.1016/j.jaip.2013.11.009