Risk Factors and Characteristics of Biphasic Anaphylaxis

被引：37

作者：

Kraft, Magdalena ^{[1
,2
,3
,4
]}

Hofmeier, Kathrin Scherer ^{[5
]}

Rueeff, Franziska ^{[6
]}

Pfoehler, Claudia ^{[7
]}

Renaudin, Jean-Marie ^{[8
]}

Bilo, Maria Beatrice ^{[9
]}

Treudler, Regina ^{[10
,11
]}

Lang, Roland ^{[12
]}

Cichocka-Jarosz, Ewa ^{[13
]}

Fernandez-Rivas, Montserrat ^{[14
]}

Christoff, George ^{[15
,16
]}

Papadopoulos, Nikolaos G. ^{[17
,18
]}

Ensina, Luis Felipe ^{[19
]}

Hourihane, Jonathan O'B ^{[20
,21
,22
]}

Maris, Ioana ^{[23
]}

Koehli, Alice ^{[24
]}

Garcia, Blanca E. ^{[25
]}

Jappe, Uta ^{[26
,27
]}

Vogelberg, Christian ^{[28
]}

Ott, Hagen ^{[29
]}

Lange, Lars ^{[30
]}

Spindler, Thomas ^{[31
]}

Doelle-Bierke, Sabine ^{[1
,2
,3
,4
]}

Worm, Margitta ^{[1
,2
,3
,4
]}

机构：

[1] Charite Univ Med Berlin, Dept Dermatol Venerol & Allergol, Div Allergy & Immunol, Charitepl 1, D-10117 Berlin, Germany

[2] Free Univ Berlin, Berlin, Germany

[3] Humboldt Univ, Berlin, Germany

[4] Berlin Inst Hlth, Berlin, Germany

[5] Univ Basel, Univ Hosp Basel, Dept Dermatol, Div Allergy, Basel, Switzerland

[6] Klinikum Univ Munchen, Dept Dermatol & Allergol, Munich, Germany

[7] Saarland Univ, Dept Dermatol, Med Ctr, Homburg, Germany

[8] Presidency Behalf Allergy Vigilance Network, Vandoeuvre Les Nancy, France

[9] Marche Polytech Univ, Univ Hosp Osped Riuniti Ancona, Dept Clin & Mol Sci, Allergy Unit, Ancona, Italy

[10] Univ Hosp, Dept Dermatol Venereol & Allergol, Leipzig, Germany

[11] Univ Hosp, Leipzig Interdisciplinary Ctr Allergol LICA, Comprehens Allergy Ctr, Leipzig, Germany

[12] Paracelsus Med Univ Salzburg, Univ Hosp Salzburg, Dept Dermatol & Allergol, Salzburg, Austria

[13] Jagiellonian Univ, Dept Pediat, Med Coll, Krakow, Poland

[14] Univ Complutense, Hosp Clin San Carlos, Dept Allergy, IdISSC, Madrid, Spain

[15] Med Univ Sofia, Fac Publ Hlth, Sofia, Bulgaria

[16] Tokuda Med Ctr, Allergy Out Patient Dept, Acibadem CityClin, Sofia, Bulgaria

[17] Natl & Kapodistrian Univ Athens, Allergy Dept, Pediat Clin 2, Athens, Greece

[18] Univ Manchester, Div Infect Immun & Resp Med, Manchester, Lancs, England

[19] Univ Fed Sao Paulo, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, Sao Paulo, Brazil

[20] Royal Coll Surgeons Ireland, Dublin, Ireland

[21] Childrens Hlth Ireland, Dublin, Ireland

[22] Univ Coll Cork, Cork, Ireland

[23] Univ Coll Cork, Bon Secours Hosp Cork, Dept Paediat & Child Hlth, Cork, Ireland

[24] Univ Childrens Hosp Zurich, Div Allergol, Zurich, Switzerland

[25] Complejo Hosp Navarra, Allergol Serv, Pamplona, Spain

[26] German Ctr Lung Res, Airway Res Ctr North ARCN, Res Ctr Borstel, Div Clin & Mol Allergol, Borstel, Germany

[27] Univ Lubeck, Interdisciplinary Outpatient Clin, Lubeck, Germany

[28] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dept Pediat Pneumol & Allergol, Dresden, Germany

[29] Childrens Hosp Bult, Div Pediat Dermatol & Allergol, Hannover, Germany

[30] St Marien Hosp, Dept Pediat, Bonn, Germany

[31] Hochgebirgsklin Davos, Med Campus Davos, Davos, Switzerland

来源：

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE | 2020年 / 8卷 / 10期

关键词：

Anaphylaxis; Anaphylactic reaction; Anaphylactic shock; Biphasic anaphylaxis; Biphasic reaction; Chronic urticaria; Idiopathic anaphylaxis; Anaphylaxis to peanut; Anaphylaxis to tree nut; Exercise-induced anaphylaxis; EMERGENCY-DEPARTMENT; CLINICAL PREDICTORS; CHILDREN; SEVERITY;

D O I：

10.1016/j.jaip.2020.07.036

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

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. (C) 2020 American Academy of Allergy, Asthma & Immunology

引用

页码：3388 / +

页数：14

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