Abstract
Background
A biphasic allergic reaction develops in 0.4–20% of patients with an allergic reaction,
but the incidence of severe biphasic reactions is unknown
Objective
Our objective was to assess the incidence and time of onset of clinically relevant
biphasic reactions in a Dutch emergency department (ED) cohort. Furthermore, the characteristics
of patients with a biphasic reaction and the mean observation time after an allergy-related
ED visit were assessed.
Methods
This was a single-center retrospective cohort study. We collected data from clinical
records of adult patients presenting with an allergic reaction to the ED between January
2015 and December 2019. We defined clinically relevant biphasic reactions as biphasic
reactions in which the criteria for anaphylaxis were met.
Results
Five hundred fifty-seven patients were included. Eight patients (1.4%) developed a
biphasic reaction, of which 1 (0.2% of the total inclusions) was clinically relevant.
In the subgroup of patients with an anaphylactic reaction (n = 258), those percentages
were 2.3% and 0.4%, respectively. The mean time between the initial allergic reaction
and the biphasic allergic reaction was 25.4 h (95% CI 13.2–37.6 h). The single clinically
relevant biphasic reaction occurred 30 h after the initial reaction.
Conclusions
The incidence of clinically relevant biphasic reactions in our cohort was low, with
a mean time between the initial allergic reaction and the biphasic reaction of > 24
h. Based on these single-center retrospective data, routine inpatient monitoring for
several hours does not seem warranted for all patients.
Keywords
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Article info
Publication history
Published online: October 24, 2022
Accepted:
October 11,
2022
Received in revised form:
September 30,
2022
Received:
June 24,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
