Division of Emergency Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
J Allergy Clin Immunol Pract. 2017 Sep-Oct;5(5):1194-1205. doi: 10.1016/j.jaip.2017.05.022.
Anaphylaxis is a severe hypersensitivity reaction that is rapid in onset and can result in death. The pattern of an anaphylactic reaction can be uniphasic (or monophasic), biphasic (also called delayed or late phase), or refractory in nature. The most widely cited definition of biphasic anaphylaxis is a recurrence of anaphylactic symptoms after initial resolution despite no further exposure to the trigger. Corticosteroids are thought by some to prevent the development of biphasic symptoms and, therefore, commonly used in the emergency treatment of anaphylaxis but this has not been systemtically analyzed. In this review, Ovid MEDLINE, Ovid EMBASE, Web of Science, and Scopus were searched for articles using "anaphylaxis" combined with the key terms "biphasic" and/or "corticosteroids" and/or "epinephrine." A total of 31 appropriate studies were identified. Biphasic anaphylactic reactions are more likely to occur in moderate to severe anaphylaxis or when anaphylaxis is not treated with timely epinephrine. Because of the potential detrimental adverse effects of corticosteroids and lack of compelling evidence demonstrating an effective role in reducing anaphylaxis severity or preventing biphasic anaphylaxis, we do not advocate for their routine use in anaphylaxis.
过敏反应是一种严重的超敏反应，发病迅速，可导致死亡。过敏反应的模式可以是单相（或单相）、双相（也称为延迟或晚期相）或难治性。双相过敏反应最广泛引用的定义是在初始缓解后尽管没有进一步接触触发物，但过敏症状再次出现。皮质类固醇被一些人认为可以预防双相症状的发生，因此常用于过敏反应的紧急治疗，但这并没有系统地分析过。在这篇综述中，检索了 Ovid MEDLINE、Ovid EMBASE、Web of Science 和 Scopus 数据库中使用“过敏反应”结合关键词“双相”和/或“皮质类固醇”和/或“肾上腺素”的文章。共确定了 31 项合适的研究。中度至重度过敏反应或未及时使用肾上腺素治疗过敏反应时，更有可能发生双相过敏反应。由于皮质类固醇可能产生有害的不良反应，并且缺乏令人信服的证据表明其在减轻过敏反应严重程度或预防双相过敏反应方面具有有效作用，因此我们不主张在过敏反应中常规使用皮质类固醇。
