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Related Concept Videos

Allergic Reactions: Anaphylaxis01:30

Allergic Reactions: Anaphylaxis

293
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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Allergic Reactions02:06

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Overview
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Hypersensitivities01:30

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Hypersensitivity, also known as a hypersensitivity reaction or allergic reaction, is a condition where the body's immune system reacts abnormally to a foreign substance. Such substances, that cause hypersensitivity are referred to as an allergen, could be something typically harmless to most people, like pollen or certain foods.
Types of Hypersensitivities
Hypersensitivity reactions are categorized into four types: Type 1, Type 2, Type 3, and Type 4. Each type has a distinct mechanism...
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Drug Toxicity: Allergic Reactions01:30

Drug Toxicity: Allergic Reactions

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Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial...
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Hypersensitivity Reactions: Delayed Hypersensitivity Reactions01:29

Hypersensitivity Reactions: Delayed Hypersensitivity Reactions

386
Delayed-Type Hypersensitivity (DTH), or Type IV hypersensitivity, is a cell-mediated immune response. It occurs when T cells, rather than antibodies, mediate a reaction to specific antigens. It is characterized by a delayed onset (1-2 days) and involves the recruitment of macrophages to the inflammation site.The initiation of a DTH response begins with the sensitization of T cells. During this phase, which lasts at least 1-2 weeks, antigen-specific T cells are activated, clonally expanded, and...
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Desensitization and Tachyphylaxis01:20

Desensitization and Tachyphylaxis

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Tachyphylaxis is described as a rapid decrease in response to a drug after repeated or continuous administration of the same drug dose. It is a phenomenon where the body becomes less responsive to a particular substance or intervention over time, requiring higher doses or stronger interventions to achieve the same effect. It results from adaptive changes in the body's receptors, signaling pathways, or physiological processes that occur in response to prolonged exposure to a stimulus.
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Basophil Activation Test for Allergy Diagnosis
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Biphasic, Refractory, and Persistent Anaphylaxis in Children.

Gizem Koken1, H Ilbilge Ertoy Karagol1, Sinem Polat Terece1

  • 1Department of Pediatric Allergy and Immunology, Gazi University Faculty of Medicine, Ankara, Turkey.

Clinical and Translational Allergy
|May 5, 2026
PubMed
Summary

Biphasic, refractory, and persistent anaphylaxis (BA, RA, PA) are rare pediatric phenotypes. These severe cases are linked to older age, specific triggers like drugs or venom, and require careful management.

Keywords:
anaphylaxisbiphasicchildrendrugfoodpersistentphenotyperefractoryvenom

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Area of Science:

  • Pediatric Allergy and Immunology
  • Clinical Immunology
  • Emergency Medicine

Background:

  • Anaphylaxis classification has been refined by a Delphi consensus report into biphasic, refractory, and persistent anaphylaxis (BA, RA, PA).
  • Previous studies have not comprehensively evaluated these specific anaphylaxis phenotypes in pediatric or adult populations.
  • This study aimed to identify and compare these phenotypes with conventional anaphylaxis in children.

Purpose of the Study:

  • To identify and characterize biphasic, refractory, and persistent anaphylaxis phenotypes in a pediatric cohort.
  • To compare the clinical features, triggers, management, and outcomes of these phenotypes against conventional anaphylaxis.
  • To assess the prevalence of these rare anaphylaxis phenotypes in children.

Main Methods:

  • Retrospective screening of pediatric patients (≤18 years) diagnosed with anaphylaxis over 15 years.
  • Categorization of anaphylaxis cases into conventional (Group 1) and BA, RA, PA phenotypes (Group 2).
  • Comparative analysis of demographics, triggers, clinical presentation, severity, management, and outcomes between Group 1 and Group 2.

Main Results:

  • Out of 529 anaphylaxis episodes, 6.6% were classified as BA (3.5%), RA (1.5%), or PA (1.5%).
  • These phenotypes were more prevalent in older children, associated with cardiovascular manifestations, increased severity, and higher corticosteroid use (p < 0.001).
  • Drug and venom triggers were more common in phenotypes (Group 2), while food was more frequent in conventional anaphylaxis (Group 1). Intramuscular adrenaline use showed no significant difference between groups.

Conclusions:

  • Biphasic, refractory, and persistent anaphylaxis are rare pediatric phenotypes.
  • These phenotypes are more frequently associated with drug or venom triggers and are observed in older children.
  • There are identified gaps in the appropriate use of intramuscular adrenaline for these severe anaphylaxis cases.