Experts Develop Consensus Definitions for Persistent, Refractory, and Biphasic Anaphylaxis

Published August 2020 | The Journal of Allergy and Clinical Immunology

In the past decade, pediatric emergency department visits for anaphylaxis tripled. The clinical courses for patients with anaphylaxis varies—some children experience complete symptom resolution after treatment with epinephrine, while others experience persistent or recurrent symptoms. However, there are no consistent definitions for these outcomes, hindering clinical practice and research efforts.

To address this need, researchers in the divisions of Emergency Medicine and Allergy and Immunology collaborated with national anaphylaxis experts to develop consensus anaphylaxis outcome definitions.

Using Delphi methodology—a structured group consensus technique—the 19-member multidisciplinary panel of experts completed online surveys to achieve consensus for the definitions of persistent, refractory, and biphasic anaphylaxis, as well as for persistent and biphasic non-anaphylactic reactions.

“These definitions will help standardize the language used in clinical care to delineate clinically important anaphylaxis outcomes, as well as provide a foundation for researchers to evaluate the epidemiology of anaphylaxis,” says lead author Timothy Dribin, MD. “Ultimately, we hope they will aid in the development of optimal care strategies to reduce the burden of anaphylaxis on patients, families, and the U.S. healthcare system.”

Currently, Dribin’s research team is applying these definitions in a multi-site retrospective study of over 6,000 children with anaphylaxis to evaluate the incidence and risk factors for persistent, refractory, and biphasic anaphylaxis. The research team also is enrolling a prospective cohort of children with anaphylaxis in the emergency department at Cincinnati Children’s.

Algorithm for Applying the Anaphylaxis Outcome Definitions in Clinical Care and Research