The postanaphylaxis dilemma How long is long eno

Authors: Stephen F Kemp

Publish Date: 2008/01/30

Volume: 8, Issue: 1, Pages: 45-48

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Abstract

Anaphylaxis may recur 1 to 72 hours after initial signs and symptoms apparently resolve Reported incidence of biphasic anaphylaxis varies from 1 to 23 Latephase severity varies from mild to severe rarely fatal No evidence or expert consensus presently identifies distinguishing characteristics in the initial phase that predict a late phase However reports propose potential risk factors including initial phase severity delayed or suboptimal doses of epinephrine during initial treatment laryngeal edema or hypotension during initial phase delayed symptomatic onset after antigen exposure or history of biphasic anaphylaxis It is unclear whether systemic corticosteroids administered in the initial phase can prevent or weaken latephase reactions Based on available evidence observation periods after complete resolution of uniphasic anaphylaxis should be individualized particularly because there are no reliable predictors of biphasic anaphylaxis A 10hour observation period appears sufficient but some investigators recommend 24 hours

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