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Biphasic anaphylactic reactions in pediatrics.

J M Lee1, D S Greenes

  • 1Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

Pediatrics
|October 4, 2000
PubMed
Summary

Biphasic reactions occur in 6% of pediatric anaphylaxis cases, with significant reactions in 3%. Delayed epinephrine administration increases this risk, while 24-hour observation benefits few patients.

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Area of Science:

  • Pediatric Allergy and Immunology
  • Emergency Medicine
  • Clinical Pediatrics

Background:

  • Anaphylaxis, a severe allergic reaction, can present with biphasic reactions, characterized by a recurrence of symptoms after initial improvement.
  • Understanding the incidence and predictors of biphasic reactions is crucial for optimizing patient management and reducing morbidity.

Purpose of the Study:

  • To determine the incidence of biphasic reactions in pediatric anaphylaxis.
  • To identify risk factors predicting biphasic reactions.
  • To assess the utility of inpatient observation for children with resolved anaphylaxis.

Main Methods:

  • Retrospective analysis of children admitted with acute anaphylaxis between 1985 and 1999.
  • Data collection on medical history, symptoms, treatment, and hospital course.
  • Definition of biphasic reactions and significant biphasic reactions.

Main Results:

  • An overall incidence of 6% for biphasic reactions and 3% for significant biphasic reactions was observed.
  • Delayed subcutaneous epinephrine administration was linked to a higher incidence of biphasic reactions.
  • Only 2% of patients benefited from a 24-hour observation period.

Conclusions:

  • Pediatric anaphylaxis has a 6% incidence of biphasic reactions, with 3% being significant.
  • Delayed epinephrine is a risk factor for biphasic reactions.
  • A 24-hour observation period offers limited clinical benefit for most pediatric anaphylaxis patients.

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