BACKGROUND: One of the main reasons for hospital admission once a child has been stabilized following anaphylaxis is to monitor for a biphasic reaction. However, only a small percentage of anaphylactic episodes involve biphasic reactions that would benefit from admission. Identification of predictive factors for a biphasic reaction would assist in determining who may benefit from prolonged observation. OBJECTIVE: To determine predictive factors for biphasic reactions in children presenting with anaphylaxis. METHODS: This was a retrospective study of children presenting with anaphylaxis to a major paediatric emergency department over a 5-year period. RESULTS: There were 95 uniphasic (87%), 12 (11%) biphasic and two protracted reactions (2%). One child with a protracted reaction died. For the management of the primary anaphylactic reaction, children developing biphasic reactions were more likely to have received >1 dose of adrenaline (58% vs. 22%, P=0.01) and/or a fluid bolus (42% vs. 8%, P=0.01) than those experiencing uniphasic reactions. The absence of either factor was strongly predictive of the absence of a biphasic reaction (negative predictive value 99%), but the presence of either factor was poorly predictive of a biphasic reaction (positive predictive value of 32%). All biphasic reactors, in which the second phase was anaphylactic, received either >1 dose of adrenaline and/or a fluid bolus. CONCLUSIONS: Children who received >1 dose of adrenaline and/or a fluid bolus for treatment of their primary anaphylactic reaction were at increased risk of developing a biphasic reaction.
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机译：背景：过敏反应使儿童稳定后一旦入院的主要原因之一就是监测双相反应。然而，只有一小部分过敏性发作涉及双相反应，这将从入院中受益。确定双相反应的预测因素将有助于确定谁可能会受益于长期观察。目的：确定有过敏反应的儿童双相反应的预测因素。方法：这是一项对5年期间出现在主要儿科急诊科的过敏反应儿童的回顾性研究。结果：单相有95个（87％），双相有12个（11％）和两个长期反应（2％）。一名反应长期的儿童死亡。为了控制原发性过敏反应，发生双相反应的儿童更有可能接受大于1剂量的肾上腺素（58％比22％，P = 0.01）和/或静脉推注（42％比8％）， P = 0.01）。两种因素均不存在可强烈预测不存在双相反应（阴性预测值为99％），但两种因素均不易预测为双相反应（阳性预测值为32％）。所有第二阶段为过敏性的双相反应器，均接受> 1剂量的肾上腺素和/或液体推注。结论：接受大于1剂量肾上腺素和/或静脉推注治疗其原发性过敏反应的儿童患双相反应的风险增加。
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