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Anaphylaxis is a severe, life-threatening hypersensitivity reaction mediated by Immunoglobulin E (IgE) antibodies. When IgE binds to allergens, it triggers the release of mediators– histamine, leukotrienes, and prostaglandins from mast cells and basophils. These mediators cause vasodilation, edema, and inflammation, leading to various symptoms.The primary allergens causing anaphylaxis include food items (e.g., peanuts, shellfish), drugs (e.g., penicillin, asparaginase, corticotropin,...
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Measuring Local Anaphylaxis in Mice
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Multiphasic anaphylaxis in the emergency and intensive care setting.

Margret Ann Schneider1, Hans de Groot2, Jan-Willem Geerts3

  • 1Intensive Care, Reinier de Graaf Gasthuis, Delft, Netherlands.

BMJ Case Reports
|February 26, 2026
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Summary

Multiphasic anaphylaxis, a severe allergic reaction recurrence, presents challenges due to unclear risks and management. This case report details a patient with recurrent anaphylaxis, suggesting a potential link to systemic mastocytosis.

Keywords:
Adult intensive careAllergyAnaphylaxisPrehospitalResuscitation

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Area of Science:

  • Allergy and Immunology
  • Clinical Medicine

Background:

  • Anaphylaxis is a severe allergic reaction requiring immediate treatment.
  • Biphasic or multiphasic anaphylaxis involves symptom recurrence despite initial treatment, posing clinical challenges.
  • Current guidelines lack clear strategies for managing recurrent anaphylaxis, particularly multiphasic cases.

Purpose of the Study:

  • To present a case of multiphasic anaphylaxis.
  • To explore potential underlying conditions contributing to recurrent anaphylaxis.
  • To provide insights into the clinical management of complex anaphylaxis cases.

Main Methods:

  • Case report of a woman in her 60s experiencing multiphasic anaphylaxis.
  • Clinical analysis of the patient's reaction to clarithromycin.
  • Investigation into potential associated conditions, including systemic mastocytosis.

Main Results:

  • The patient experienced recurrent anaphylaxis despite standard treatment.
  • Analysis indicated a high likelihood of systemic mastocytosis.
  • Formal diagnostic criteria for systemic mastocytosis were not met by the patient.

Conclusions:

  • Multiphasic anaphylaxis requires careful consideration of underlying conditions.
  • Systemic mastocytosis may be associated with recurrent anaphylaxis, even without meeting diagnostic criteria.
  • Case reports are valuable for understanding and managing rare clinical presentations of anaphylaxis.