Risk Factors and Characteristics of Biphasic Anaphylaxis

• Published in: The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 8; no. 10; pp. 3388 - 3395.e6
• Main Authors: Kraft, Magdalena, Scherer Hofmeier, Kathrin, Ruëff, Franziska, Pföhler, Claudia, Renaudin, Jean-Marie, Bilò, Maria Beatrice, Treudler, Regina, Lang, Roland, Cichocka-Jarosz, Ewa, Fernandez-Rivas, Montserrat, Christoff, George, Papadopoulos, Nikolaos G., Ensina, Luis Felipe, Hourihane, Jonathan O’B., Maris, Ioana, Koehli, Alice, García, Blanca E., Jappe, Uta, Vogelberg, Christian, Ott, Hagen, Lange, Lars, Spindler, Thomas, Dölle-Bierke, Sabine, Worm, Margitta
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2020; Elsevier Limited
• Subjects: Age; Anaphylactic reaction; Anaphylactic shock; Anaphylaxis; Anaphylaxis - diagnosis; Anaphylaxis - epidemiology; Anaphylaxis to peanut; Anaphylaxis to tree nut; Antihistamines; Biphasic anaphylaxis; Biphasic reaction; Chronic urticaria; Cohort Studies; Epinephrine; Exercise-induced anaphylaxis; Food; Humans; Hypersensitivity (immediate); Idiopathic anaphylaxis; Odds Ratio; Questionnaires; Risk assessment; Risk Factors; Urticaria; Germany; Biphasic anaphylaxis; OR; CI; FAAN; Biphasic reaction; Anaphylaxis to tree nut; Anaphylaxis to peanut; NIAID; Chronic urticaria; Idiopathic anaphylaxis; Exercise-induced anaphylaxis; Anaphylaxis; Anaphylactic shock; Anaphylactic reaction
• ISSN: 2213-2198; 2213-2201
• DOI: 10.1016/j.jaip.2020.07.036

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.
To identify factors predisposing for biphasic anaphylaxis for the better understanding of these reactions.
Data from the Anaphylaxis Registry (from 11 countries) including 8736 patients with monophasic and 435 biphasic anaphylaxis were analyzed.
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).
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.