Biphasic and protracted anaphylaxis
- Phillip L Lieberman, MD
Phillip L Lieberman, MD
- Clinical Professor of Medicine and Pediatrics
- University of Tennessee College of Medicine
Most episodes of anaphylaxis begin quickly, escalate, and then resolve completely, particularly when appropriate treatment is administered. However, some anaphylactic reactions resolve and recur hours later or do not resolve completely for hours or even days.
Atypical patterns of anaphylaxis, the incidence of atypical patterns of reactions, and proposed risk factors for these reactions will be reviewed here. The diagnosis and treatment of anaphylaxis, fatal anaphylaxis, and other topics related to anaphylaxis are discussed elsewhere. (See "Anaphylaxis: Emergency treatment" and "Fatal anaphylaxis" and "Differential diagnosis of anaphylaxis in children and adults".)
DEFINITIONS AND INCIDENCE
There are three recognized temporal patterns of anaphylaxis: uniphasic, biphasic, and protracted .
Uniphasic anaphylaxis — Uniphasic anaphylactic reactions are the most common type, accounting for an estimated 80 to 90 percent of all episodes. A uniphasic response usually peaks within 30 minutes to one hour after symptoms appear and resolves either spontaneously or with treatment within the next 30 minutes to one hour.
Protracted anaphylaxis — A protracted anaphylactic reaction lasts hours to days without clearly resolving completely. The exact frequency of protracted episodes of anaphylaxis is unknown, although they appear to be uncommon. The literature consists only of case reports and small series [2-6].
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- DEFINITIONS AND INCIDENCE
- Uniphasic anaphylaxis
- Protracted anaphylaxis
- Biphasic anaphylaxis
- CLINICAL CHARACTERISTICS
- Protracted reactions
- Biphasic reactions
- - Severity of recurrent symptoms
- - Timing of recurrent symptoms
- THEORIES OF PATHOGENESIS
- POSSIBLE RISK FACTORS
- Severe initial symptoms
- Suboptimal or delayed treatment of initial reaction
- - Epinephrine
- - Glucocorticoids
- Delayed resolution of initial symptoms
- Ingested allergens
- Other factors
- IMPLICATIONS FOR OBSERVATION AND ADMISSION
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS