Biphasic Reactions in Children Undergoing Oral Food Challenges
Division of Allergy and Immunology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA.Allergy and Asthma Proceedings (Impact Factor: 3.06). 05/2013; 34(3):220-6. DOI: 10.2500/aap.2013.34.3669
Literature regarding biphasic reactions in the pediatric population is sparse. We aimed to determine the prevalence of biphasic reactions in children with food allergies undergoing oral food challenges (OFCs) and examine whether any clinical or treatment factors are associated with biphasic reactions. A retrospective chart review of OFCs conducted between July 2007 and March 2011 was performed. Charts were reviewed from time of challenge to 48 hours after challenge to capture data on any biphasic reactions. Uniphasic and biphasic reactions were compared in terms of specific clinical features and treatments. Of 614 positive challenges, 9 resulted in a biphasic reaction (1.5%). Six of the biphasic reactions occurred in challenges where the initial reaction met anaphylaxis criteria. The biphasic reactions were to eggs (4), peanuts (3), and milk (2). The symptom-free interval ranged from 2 to 24 hours. There were no statistically significant differences in clinical features between uniphasic and biphasic reactions, but there appeared to be a higher percentage of initial reactions with multiple organ involvement and meeting anaphylaxis criteria in the biphasic group. Biphasic reactors were significantly more likely to have received steroids for their initial reaction. A higher percentage of biphasic reactors also appeared to have received epinephrine, multiple doses of epinephrine, and antihistamines for their initial reactions. Biphasic reactions are rare in children undergoing OFCs and may be associated with more severe allergic reactions. Children with severe reactions may benefit from a 24-hour period of observation.
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ABSTRACT: Food allergy affects up to 10% of preschool children, and continues to increase in prevalence in many countries, resulting in a major public health issue, with practical implications for the food industry, educational establishments and healthcare systems. The need to distinguish between food allergen sensitization and true clinical reactivity remains crucial in diagnosis, often requiring formal food challenge to avoid unnecessary dietary elimination. Epicutaneous exposure in the absence of oral tolerance induction during infancy may be an important risk factor for food allergy. Mounting evidence suggests that for milk and egg allergens, many children are able to tolerate the food when heat-modified, and that this may hasten resolution of the allergy. These developments will hopefully result in a lower adverse impact on quality of life for food-allergic individuals and their families.03/2014; 17(3). DOI:10.1097/MCO.0000000000000052
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ABSTRACT: A biphasic reaction is the recurrence of anaphylaxis symptoms within 72 hours of the initial anaphylactic event, without re-exposure to the trigger. Biphasic reactions are uncommon and unpredictable, and risk factors for biphasic reactions are poorly understood. To identify predictors of biphasic anaphylactic reactions in patients with anaphylaxis in the emergency department (ED). Patients of all ages who presented to the ED and met diagnostic criteria for anaphylaxis from April 2008 to January 2013 at an academic medical center with 73,000 annual patient visits were consecutively included. We collected data on patient characteristics, suspected triggers, signs and symptoms, ED management, and disposition. Univariate analyses were performed to estimate the association between potential predictor variables and biphasic reactions. We report associations as odds ratios (OR) and corresponding 95% CIs. Among 541 patients with anaphylaxis, median age was 34.6 years (interquartile range, 18-52 years), and 320 (59%) were female patients. Twenty-one patients (4%) had biphasic reactions. Two pediatric patients, ages of 5 years old and 16 years old, developed a biphasic reaction. The median time between the resolution of initial symptoms and onset of the biphasic reaction was 7 hours (range, 1-72 hours). Biphasic reactions were associated with a history of prior anaphylaxis (OR 2.6 [95% CI, 1.1-6.4]; P = .029), unknown precipitant (OR 2.6 [95% CI, 1.1-6.2]; P = .03), symptoms of diarrhea (OR 4.5 [95% CI, 1.4-14.0]; P = .024), and wheezing (OR 2.6 [95% CI, 1.4-8.9]; P = .029). Patients with a history of prior anaphylaxis, an unknown precipitant, or who present with symptoms of diarrhea or wheezing may be at increased risk for a biphasic reaction.05/2014; 2(3):281-7. DOI:10.1016/j.jaip.2014.01.012
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ABSTRACT: Food allergy risk is increased in children with gastroesophageal reflux, and even more increased when these children are treated by anti-acids. Most children with suspected food allergy are not allergic to foods. Thus, a well-conducted allergological work-up is necessary to avoid familial anxiety and food evictions that may be harmful for the children. Frequent consultations at the allergist's office are associated with a better identification of severity and a better emergency treatment of anaphylactic reactions by the parents. Specialized 24 h/24 helplines and educational support provided during activity holidays are associated with a significant benefit on management of food-induced anaphylaxis by the parents and the children themselves. Finally, reactivity to wheat may vary according to the wheat-containing foods administered to the children, and children tolerant to wheat cereal biscuits may react to other wheat-containing foods such as bread or pasta. If many children report suspected allergic reactions to drugs, only a few of these children are truly suffering from drug hypersensitivity, except for children reporting reactions to non-opioid analgesics, antipyretics and non-steroidal anti-inflammatory drugs. Once more, it is shown that drug challenges should be performed at home and prolonged in children reporting non-immediate reactions, at the risk of underdiagnosing drug hypersensitivity. Finally, hymenoptera venom immunotherapy is efficient in children, and its efficacity persists during 7–8 years at least.Revue Française d'Allergologie 09/2014; 54(5). DOI:10.1016/j.reval.2014.01.002 · 0.25 Impact Factor
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