Magdalena Kraft1, Kathrin Scherer Hofmeier2, Franziska Ruëff3, Claudia Pföhler4, Jean-Marie Renaudin5, Maria Beatrice Bilò6, Regina Treudler7, Roland Lang8, Ewa Cichocka-Jarosz9, Montserrat Fernandez-Rivas10, George Christoff11, Nikolaos G Papadopoulos12, Luis Felipe Ensina13, Jonathan O'B Hourihane14, Ioana Maris15, Alice Koehli16, Blanca E García17, Uta Jappe18, Christian Vogelberg19, Hagen Ott20, Lars Lange21, Thomas Spindler22, Sabine Dölle-Bierke1, Margitta Worm23. 1. Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. 2. Division of Allergy, Department of Dermatology, University Hospital Basel, University of Basel, Basel, Switzerland. 3. Department of Dermatology and Allergology, Klinikum der Universität München, Munich, Germany. 4. Department of Dermatology, The Saarland University Medical Center, Homburg/Saar, Germany. 5. Presidency on behalf of Allergy Vigilance Network, Vandoeuvre les Nancy, France. 6. Department of Clinical and Molecular Sciences, Marche Polytechnic University - Allergy Unit, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy. 7. Department of Dermatology, Venereology and Allergology and Leipzig Interdisciplinary Center of Allergology (LICA) - Comprehensive Allergy Center, University Hospital, Leipzig, Germany. 8. Department of Dermatology and Allergology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria. 9. Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland. 10. Department of Allergy, Hospital Clinico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain. 11. Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria; Allergy Out-patient Department, Acibadem CityClinic, Tokuda Medical Centre, Sofia, Bulgaria. 12. Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece; Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom. 13. Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. 14. Royal College of Surgeons in Ireland and Childrens Health Ireland, Dublin, Ireland; University College Cork, Cork, Ireland. 15. Bon Secours Hospital Cork/Department of Paediatrics and Child Health, University College Cork, Cork, Ireland. 16. Division of Allergology, University Children's Hospital Zurich, Zurich, Switzerland. 17. Allergology Service, Complejo Hospitalario de Navarra, Pamplona, Spain. 18. Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research, Borstel, Germany; Interdisciplinary Outpatient Clinic, University of Lübeck, Lübeck, Germany. 19. Department of Pediatric Pneumology and Allergology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. 20. Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany. 21. Department for Pediatrics, St. Marien-Hospital, Bonn, Germany. 22. Medicine Campus Davos, Hochgebirgsklinik Davos, Davos, Switzerland. 23. Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. Electronic address: margitta.worm@charite.de.
Abstract
BACKGROUND: Anaphylaxis is an immediate hypersensitivity reaction. However, a biphasic course with the second onset of symptoms can occur hours after the initial phase. Little is known about the causes of biphasic anaphylaxis making the identification of patients at risk difficult. OBJECTIVE: To identify factors predisposing for biphasic anaphylaxis for the better understanding of these reactions. METHODS: Data from the Anaphylaxis Registry (from 11 countries) including 8736 patients with monophasic and 435 biphasic anaphylaxis were analyzed. RESULTS: The rate of biphasic reactions in this large cohort was 4.7%. The identified risk factors were reaction severity (grade III/IV vs grade II: odds ratio [OR] = 1.34; 95% confidence interval [CI]: 1.1-1.62); multiorgan involvement; skin, gastrointestinal, severe respiratory, and cardiac symptoms; anaphylaxis caused by peanut/tree nut (OR = 1.78; 95% CI: 1.38-2.23) or an unknown elicitor (OR = 1.96; 95% CI: 1.41-2.72); exercise as a cofactor (OR = 1.44; 95% CI: 1.17-1.78); chronic urticaria as a comorbidity (OR = 2.12; 95% CI: 1.19-3.78); a prolonged interval between the contact with the elicitor and start of primary symptoms (OR for >30 vs <30 min: 1.38; 95% CI: 1.08-1.76); and antihistamine treatment (OR = 1.52; 95% CI: 1.14-2.02). CONCLUSION: A biphasic course of anaphylaxis occurs more frequently in severely affected patients with multiorgan involvement. However, we identified multiple additional predictors, suggesting that the pathogenesis of biphasic reactions is more complex than being a rebound of a severe primary reaction.
BACKGROUND:Anaphylaxis is an immediate hypersensitivity reaction. However, a biphasic course with the second onset of symptoms can occur hours after the initial phase. Little is known about the causes of biphasic anaphylaxis making the identification of patients at risk difficult. OBJECTIVE: To identify factors predisposing for biphasic anaphylaxis for the better understanding of these reactions. METHODS: Data from the Anaphylaxis Registry (from 11 countries) including 8736 patients with monophasic and 435 biphasic anaphylaxis were analyzed. RESULTS: The rate of biphasic reactions in this large cohort was 4.7%. The identified risk factors were reaction severity (grade III/IV vs grade II: odds ratio [OR] = 1.34; 95% confidence interval [CI]: 1.1-1.62); multiorgan involvement; skin, gastrointestinal, severe respiratory, and cardiac symptoms; anaphylaxis caused by peanut/tree nut (OR = 1.78; 95% CI: 1.38-2.23) or an unknown elicitor (OR = 1.96; 95% CI: 1.41-2.72); exercise as a cofactor (OR = 1.44; 95% CI: 1.17-1.78); chronic urticaria as a comorbidity (OR = 2.12; 95% CI: 1.19-3.78); a prolonged interval between the contact with the elicitor and start of primary symptoms (OR for >30 vs <30 min: 1.38; 95% CI: 1.08-1.76); and antihistamine treatment (OR = 1.52; 95% CI: 1.14-2.02). CONCLUSION: A biphasic course of anaphylaxis occurs more frequently in severely affected patients with multiorgan involvement. However, we identified multiple additional predictors, suggesting that the pathogenesis of biphasic reactions is more complex than being a rebound of a severe primary reaction.
Authors: Andrew F Whyte; Jasmeet Soar; Amy Dodd; Anna Hughes; Nicholas Sargant; Paul J Turner Journal: Clin Med (Lond) Date: 2022-07 Impact factor: 5.410
Authors: Amy Dodd; Anna Hughes; Nicholas Sargant; Andrew F Whyte; Jasmeet Soar; Paul J Turner Journal: Resuscitation Date: 2021-04-23 Impact factor: 5.262
Authors: M Kraft; J M Renaudin; L F Ensina; A Kleinheinz; M B Bilò; K Scherer Hofmeier; S Dölle-Bierke; M Worm Journal: J Eur Acad Dermatol Venereol Date: 2021-06-01 Impact factor: 9.228
Authors: Paul J Turner; Stefania Arasi; Barbara Ballmer-Weber; Alessia Baseggio Conrado; Antoine Deschildre; Jennifer Gerdts; Susanne Halken; Antonella Muraro; Nandinee Patel; Ronald Van Ree; Debra de Silva; Margitta Worm; Torsten Zuberbier; Graham Roberts Journal: Allergy Date: 2022-04-28 Impact factor: 14.710