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Biphasic anaphylactic reactions.

Phil Lieberman1

  • 1Department of Medicine and Pediatrics, University of Tennessee College of Medicine, Germantown, Tennessee, USA. aac@allergymemphis.com

Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology
|October 5, 2005
PubMed
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Biphasic anaphylaxis reactions can occur up to 72 hours after initial symptoms resolve. Extended observation periods, potentially 24 hours, are recommended due to the significant frequency of these late-phase reactions.

Area of Science:

  • Anaphylaxis and Allergy Research
  • Immunology
  • Clinical Medicine

Background:

  • Biphasic anaphylaxis involves a recurrence of symptoms after an initial reaction.
  • The timing and predictors of these secondary reactions remain incompletely understood.
  • Determining appropriate observation times post-anaphylaxis is crucial for patient safety.

Purpose of the Study:

  • To evaluate the impact of biphasic anaphylaxis on recommended post-symptom observation durations.
  • To synthesize current literature on the characteristics and risk factors of biphasic reactions.

Main Methods:

  • A comprehensive MEDLINE literature search was conducted for studies on biphasic anaphylaxis from 1970 to 2005.
  • Keywords included anaphylaxis, biphasic anaphylaxis, and late/early phase reactions.

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  • Inclusion criteria encompassed prospective studies, retrospective studies, and case reports.

    • Main Results:

    • The incidence of biphasic anaphylaxis varies widely (1%-20%).
    • Risk factors mentioned include reaction severity, onset time, hypotension, laryngeal edema, and prior biphasic reactions.
    • Late-phase reactions are typically mild to moderate, but can be severe, with rare fatalities.

    Conclusions:

    • Biphasic responses occur frequently, necessitating consideration in observation period planning.
    • While 8 hours may suffice for many, a 24-hour observation period is suggested by some due to reactions occurring up to 72 hours post-initial event.