Clinical predictors for biphasic reactions in children presenting with anaphylaxis

被引:60
作者
Mehr, S. [1 ,2 ]
Liew, W. K. [1 ,3 ]
Tey, D. [1 ]
Tang, M. L. K. [1 ,4 ,5 ]
机构
[1] Royal Childrens Hosp, Dept Allergy & Immunol, Melbourne, Vic, Australia
[2] Univ Sydney, Westmead Clin Sch, Childrens Hosp, Discipline Paediat & Child Hlth, Sydney, NSW 2006, Australia
[3] KK Womens & Childrens Hosp, Dept Paediat Allergy Immunol & Rheumatol, Singapore, Singapore
[4] Murdoch Childrens Res Inst, Melbourne, Vic, Australia
[5] Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia
关键词
anaphylaxis; biphasic; children; EMERGENCY;
D O I
10.1111/j.1365-2222.2009.03276.x
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
P>Background One of the main reasons for hospital admission once a child has been stabilized following anaphylaxis is to monitor for a biphasic reaction. However, only a small percentage of anaphylactic episodes involve biphasic reactions that would benefit from admission. Identification of predictive factors for a biphasic reaction would assist in determining who may benefit from prolonged observation. Objective To determine predictive factors for biphasic reactions in children presenting with anaphylaxis. Methods This was a retrospective study of children presenting with anaphylaxis to a major paediatric emergency department over a 5-year period. Results There were 95 uniphasic (87%), 12 (11%) biphasic and two protracted reactions (2%). One child with a protracted reaction died. For the management of the primary anaphylactic reaction, children developing biphasic reactions were more likely to have received > 1 dose of adrenaline (58% vs. 22%, P=0.01) and/or a fluid bolus (42% vs. 8%, P=0.01) than those experiencing uniphasic reactions. The absence of either factor was strongly predictive of the absence of a biphasic reaction (negative predictive value 99%), but the presence of either factor was poorly predictive of a biphasic reaction (positive predictive value of 32%). All biphasic reactors, in which the second phase was anaphylactic, received either > 1 dose of adrenaline and/or a fluid bolus. Conclusions Children who received > 1 dose of adrenaline and/or a fluid bolus for treatment of their primary anaphylactic reaction were at increased risk of developing a biphasic reaction.
引用
收藏
页码:1390 / 1396
页数:7
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