Byuk Sung Ko1, Won Young Kim2, Seung Mok Ryoo1, Shin Ahn1, Chang Hwan Sohn1, Dong-Woo Seo1, Yoon-Seon Lee1, Kyoung Soo Lim1, Tae-Bum Kim3. 1. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 2. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: wonpia73@naver.com. 3. Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Abstract
BACKGROUND: Although the incidence of anaphylaxis is rapidly increasing, the clinical characteristics and associated factors of a biphasic reaction are unclear. OBJECTIVE: To determine the incidence and clinical characteristics of biphasic reactions in patients with anaphylaxis treated with corticosteroids. METHODS: A total of 655 patients with anaphylaxis visiting the emergency department of a tertiary teaching hospital from January 2007 through December 2014 were analyzed. Patient characteristics, triggers, symptoms and signs, in-hospital management, and disposition were recorded. A biphasic reaction was defined as the development of anaphylaxis after complete resolution of the initial reaction without further exposure to the offending agent within 7 days. Univariate and multivariate analyses on the predictors of the biphasic reaction were performed. RESULTS: Of the 415 patients with anaphylaxis treated with corticosteroids, 9 patients (2.2%) developed a biphasic reaction. The mean age was 48.4 years, and 221 patients (54.4%) were women. The median time from complete resolution of initial clinical symptoms to occurrence of the biphasic reaction was 15 hours (range 1-45). History of drug anaphylaxis (odds ratio 14.3, 95% confidence interval 2.4-85.8) was a contributing factor to the development of the biphasic reaction. CONCLUSION: The incidence of biphasic reactions was 2.2% in patients treated with corticosteroids and those with a history of drug anaphylaxis were at greater risk.
BACKGROUND: Although the incidence of anaphylaxis is rapidly increasing, the clinical characteristics and associated factors of a biphasic reaction are unclear. OBJECTIVE: To determine the incidence and clinical characteristics of biphasic reactions in patients with anaphylaxis treated with corticosteroids. METHODS: A total of 655 patients with anaphylaxis visiting the emergency department of a tertiary teaching hospital from January 2007 through December 2014 were analyzed. Patient characteristics, triggers, symptoms and signs, in-hospital management, and disposition were recorded. A biphasic reaction was defined as the development of anaphylaxis after complete resolution of the initial reaction without further exposure to the offending agent within 7 days. Univariate and multivariate analyses on the predictors of the biphasic reaction were performed. RESULTS: Of the 415 patients with anaphylaxis treated with corticosteroids, 9 patients (2.2%) developed a biphasic reaction. The mean age was 48.4 years, and 221 patients (54.4%) were women. The median time from complete resolution of initial clinical symptoms to occurrence of the biphasic reaction was 15 hours (range 1-45). History of drug anaphylaxis (odds ratio 14.3, 95% confidence interval 2.4-85.8) was a contributing factor to the development of the biphasic reaction. CONCLUSION: The incidence of biphasic reactions was 2.2% in patients treated with corticosteroids and those with a history of drug anaphylaxis were at greater risk.
Authors: Timothy E Dribin; Kenneth A Michelson; Michael C Monuteaux; Anne M Stack; Karen S Farbman; Lynda C Schneider; Mark I Neuman Journal: PLoS One Date: 2019-02-07 Impact factor: 3.240
Authors: Timothy E Dribin; Kenneth A Michelson; David Vyles; Mark I Neuman; David C Brousseau; Rakesh D Mistry; Peter S Dayan; Nanhua Zhang; Shiv Viswanathan; John Witry; Stephanie Boyd; David Schnadower Journal: BMJ Open Date: 2021-01-05 Impact factor: 2.692
Authors: Mitchell M Pitlick; Miguel A Park; Alexei Gonzalez-Estrada; Sergio E Chiarella Journal: Ann Allergy Asthma Immunol Date: 2021-07-31 Impact factor: 6.347