Gizem Koken, H Ilbilge Ertoy Karagol, Sinem Polat Terece, Ceren Varer Akpinar, Kenan Cetin, Zeynep Cavdar, Berkehan Kara, A Kubra Baskin, Arzu Bakirtas
{"title":"Biphasic, Refractory, and Persistent Anaphylaxis in Children.","authors":"Gizem Koken, H Ilbilge Ertoy Karagol, Sinem Polat Terece, Ceren Varer Akpinar, Kenan Cetin, Zeynep Cavdar, Berkehan Kara, A Kubra Baskin, Arzu Bakirtas","doi":"10.1002/clt2.70174","DOIUrl":"10.1002/clt2.70174","url":null,"abstract":"<p><strong>Background: </strong>A Delphi consensus report refined anaphylaxis phenotypes as biphasic, refractory, and persistent anaphylaxis (BA, RA, and PA). To date, no study in either pediatric or adult populations has comprehensively evaluated the full spectrum of anaphylaxis phenotypes as outlined in this consensus. The primary aim of this study was to identify these phenotypes and compare them with conventional anaphylaxis in children.</p><p><strong>Methods: </strong>Patients aged ≤ 18 years who were diagnosed with or followed up for anaphylaxis at our department over the past 15 years were retrospectively screened for this study. All anaphylaxis cases were categorized as conventional anaphylaxis (Group 1) or as BA, RA, and PA phenotypes (Group 2). A comparative analysis was conducted between Group 1 and Group 2 with respect to demographics, triggers, clinical features, severity, management, and outcomes.</p><p><strong>Results: </strong>A total of 393 patients and 529 anaphylaxis episodes were included. Twenty-six (6.6%) of all anaphylaxis cases were classified as BA (3.5%), RA (1.5%), or PA (1.5%). For BA, the median time to recurrence of symptoms and signs was 4 h (1-24 h), whereas the median duration of PA manifestations was 4 h (4-6 h). These phenotypes (Group 2) were more common in older children and were associated with increased cardiovascular manifestations, greater severity, and higher use of systemic corticosteroid (p < 0.001). They did not differ significantly from Group 1 with respect to gender, comorbidities, family history of atopy, timing or location of the anaphylaxis, or number of episodes. Drugs, followed by venoms, were more frequent triggers in Group 2, whereas food was significantly more common in Group 1 (p < 0.05). IM adrenaline was administered in 69.2% of Group 2 and 52.3% of Group 1, with no significant difference (p > 0.05). Comparisons among BA, RA, and PA could not be performed due to the limited sample size within each phenotype.</p><p><strong>Conclusions: </strong>BA, RA, and PA are rare anaphylaxis phenotypes, more frequently drug or venom induced, seen at older ages, with ongoing gaps in proper IM adrenaline use.</p>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"16 5","pages":"e70174"},"PeriodicalIF":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Systemic Nickel Allergy Syndrome: A Critical Appraisal of an Unvalidated Diagnostic Entity.","authors":"Antonello Giovannetti","doi":"10.1002/clt2.70169","DOIUrl":"10.1002/clt2.70169","url":null,"abstract":"<p><p>Systemic Nickel Allergy Syndrome (SNAS) remains a controversial clinical construct, characterized by persistent diagnostic uncertainty and the absence of reproducible biomarkers. Available studies are predominantly limited to small case series and uncontrolled observational reports, yielding partial and inconclusive findings. Diagnostic approaches, including oral provocation tests, frequently employ nickel exposures that far exceed typical dietary intake, raising concerns regarding physiological relevance and methodological validity. Finally, scientific inquiry into this entity has largely neglected crucial aspects such as nickel bioavailability and bioaccessibility. Against this background, particularly within the Italian clinical context, SNAS has received considerable medical and public attention despite the limited and inconsistent evidence supporting its recognition as a systemic allergic condition. Reported clinical improvements following low-nickel diets are more plausibly explained by non-specific dietary modifications-such as reduced intake of fermentable carbohydrates-rather than by a targeted immunological response to nickel. In conclusion, SNAS does not fulfill the criteria required for recognition as a discrete pathological entity. Rather, it represents a unvalidated diagnostic label for non-specific symptoms shared across established functional syndromes.</p>","PeriodicalId":10334,"journal":{"name":"Clinical and Translational Allergy","volume":"16 5","pages":"e70169"},"PeriodicalIF":4.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13181595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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