Protracted Anaphylaxis

Posted on: Sat, 01/21/2006 - 1:26pm
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After my first anaphylactic reaction (to shellfish, not peanuts) this week--and because I'm still feeling it 48+ hours later--I'm curious to know who here has experienced protracted anaphylaxis.

I thought until now that anaphylaxis could really only be uniphasic or biphasic. I knew my severe shellfish reactions required continued use of benadryl throughout the next day, but this has gone beyond that time frame.

I've done some reading on this today, and it seems that protracted anaphylaxis usually occurs when the original reaction wasn't immediate and when it occurred orally. Both were true for me--my reaction occurred almost 2 hours after eating cross contaminated food.

The past two days have not been fun--and neither was reaction day. I've given a pretty detailed description of it through several posts in the Adults with PA board under the Gastroinestinal thread.

But this has me concerned, because it's hard to recognize in myself. I felt awful this morning and better this afternoon and evening. Other than feeling bad, it was just milder versions of my symptoms that disappeared when I took benadryl.

And if it's hard to recognize in myself, then how hard will it be to recognize in DS after a reaction from peanut exposure?

Will he think to ask for benadryl or will I know to automatically give it to him "just in case" the reaction is protracted?

What have you done? Has your protracted reaction turned out to be as serious as the initial one? What else can you tell me about your experience with these types of reactions?

Posted on: Sat, 01/21/2006 - 2:45pm
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I only had to use the epi on dd once. It was for egg and the reaction started somewhere between 1 minute and 10 minutes after eating it. It is hard to remember, because it was 8 years ago. I do remember that I had to give an antihistamine for a few days and a steriod also. It could have been as short as 2 days or as long as 5 days. I really don`t remember. Her reaction was not GI. She had hives, swelling around her eyes, and wheezing. I gave the epi and she was completely fine. However, a few hours later (maybe 2 or 3 hours?) she got a rash. It did not look like hives. It was a different kind of rash. I don`t remember how long it lasted--maybe a day or two? She was otherwise fine, happy, playing, seemed to be feeling fine. Sorry I don`t have more detailed information. Do you think you should call your doctor and ask him if it is typical for you to still be feeling bad this long after?

Posted on: Sun, 01/22/2006 - 12:39am
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Hello McCobbre,
So sorry to hear that you're still feeling lousy. Any reaction I've had has only lasted about 6 hours. I felt tired the next day but not sick.
Is Benedryl helping? If not, is it possible that you are simultaneously came down with something else? It seems logical that you would be more vulnerable to viruses, etc. when you have an allergic reaction - and didn't you go to the hospital? Tons of germs there!
Just a thought....
Hope you feel better.
Adele

Posted on: Sun, 01/22/2006 - 12:53am
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Just raised this for you
[url="http://uumor.pair.com/nutalle2/peanutallergy/Forum1/HTML/004855.html"]http://uumor.pair.com/nutalle2/peanutallergy/Forum1/HTML/004855.html[/url]

Posted on: Sun, 01/22/2006 - 12:58am
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Both my kids have required antihistamines for up to a week after a reaction. They get recurrent hives. My son once had to be treated with Zyrtec and Zantac for a month for severe hives (unknown cause--could have been viral or flu shot reaction since he is allergic to eggs).
Cathy
------------------
Mom to 6 1/2 yr old PA/TNA daughter and 3 yr old son who is allergic to eggs.

Posted on: Sun, 01/22/2006 - 11:57am
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I never needed to use the epi, but my DS' recent reaction lasted a total of 10 days. At its worst, he had red spots from head-to-toe, some hives, and big red welts on the palms. I hope you feel better soon!

Posted on: Sun, 01/22/2006 - 12:05pm
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Don't forget that benadryl itself can make people feel weird. Kind of spacey and tired.

Posted on: Sun, 01/22/2006 - 12:10pm
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Momma2boys--thanks for reraising. There were a few posts in there that were especially helpful--the one about abdominal reactions specifically.
Adele--no, I don't think this is a viral thing, because the same three things keep coming back and they disappear after I have Benadryl for a few hours. And I've done enough reading about protracted reactions (different than biphasic reactions) in the last 48 hours to know that they are common enough--and they tend to appear under the same circumstances I had. This morning at church was the last time I had to take Benadryl, so I hope this thing is finished.
And yes--I do plan on talking with my doctor about this.
What's interesting is that I took the epi based on the second symptom appearing (and because it was chest tightness and pain and I'm asthmatic)--and believe I did the right thing. (I must say that I also had a headache the first day, but I'm not sure it was a symptom.) But the truth is, on the subsequent days I had more than one symptom. Indeed, the third appeared 24 hours afterward. If the Epi is given based on the number of symptoms, as I was always told, then I would have needed it on my subsequent days. But clearly I didn't. I just needed Benadryl regularly. I found the Grading of Anaphylaxis thread helpful here and a website or two that helped prioritize.
And it's helpful to see what protracted reactions others have dealt with. Thanks everyone for sharing.

Posted on: Mon, 01/23/2006 - 1:30pm
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about 6 years ago, I had an ana. reaction to a medication. I was covered in hives and my face swoll up like a soccer ball. The actual reaction lasted for almost 12 hours until all the med was out of my system. My lips and face were swollen for 4 or 5 days.
here's the weird thing...for over a year afterward all my other allergies and intolerances were worse. I was also incredibly sensitive to odors.
An example is my allergy to cats. I was allergic to cats when I was little, but I had mostly outgrown it. I even had 2 cats for 10 years until my son developed allergies to them. After anaphalaxis, I could not touch a cat without breaking out in hives and having my eyes swell up. Now, 6 years later, I can pet a cat without a reaction as long as I wash my hands. If I get cat hair or dander in my eyes, they will burn, but do not swell anymore.
On the other hand, when my dd experienced ana., she had the sudden onset of symptoms, I gave her the epipen, and she was back to normal within 30 minutes. By the time we got to the ER, you would never have known it happened to look at her...I haven't seen any new allergies or her other allergy getting worse (she is also mildly allergic to cats.)
In any case, I can relate to what you're going through and I hope you will be feeling better soon.

Posted on: Thu, 01/26/2006 - 11:00am
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My best friend is anaphylactic to latex, and occasionally has very serious reactions. She has almost died on several occasions, even with immediate use of her EpiPen and prompt medical attention. Whenever she has a serious reaction now, her allergist puts her on steroids for at least a week after to deal with the recurring symptoms. Has anyone else had this kind of treatment for a serious reaction?

Posted on: Sun, 05/21/2006 - 12:35pm
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erl
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I've had heightened sensitivity and a kind of protracted anaphylaxis about 3 years ago with 3 epi requiring reactions within 14 days, 2 of which were airborn exposure.
Now I'm 10 days into some sort of the same thing. I had a reaction to shellfish? (which would be a new allergy for me- pn, tn, sesame, chick pea) which I didn't treat with epi but should have. I've been on Prednisone, Zyrtec, Zantac and prn benadryl and albuterol. Today I had a full blown epi requiring reaction to ??airborn outdoors peanut exposure. Hopefully it will settle down.

Posted on: Sun, 05/21/2006 - 10:12pm
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sorry to hear of your situation. It stands to reason to me that symptoms could last for upwards of a week when they say that the food can stay in your system for that long. This is why when you're on an elimination diet you're supposed to wait anywhere from 3 days to 2 weeks to get it out.
Also, my dd often has a delayed reaction to things -- 4 hrs seems to be the "magic number" for her. Couldn't figure it out for a long time, but, for instance, she will not have an asthma attack while we're at my mom's house (she has a cat, dog and dust), but always 4 hrs after we've visited. But once I give her the medication it doesn't seem to recur from the same incident. Hard to tell. She gets asthma on a regular basis.
Good luck to you.

Posted on: Mon, 05/22/2006 - 12:30am
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My neighbor is allergic to aspirin and she once took Advil and experienced anaphylaxis. She was treated in the ER and they told her that aspirin or Advil reactions can go on for weeks. She experienced symptoms for weeks after that.
So if it happens with aspirin it can happen with shellfish I guess. Hope this helps.
Peg

Posted on: Mon, 10/30/2006 - 12:47pm
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raising for imgm.

Posted on: Mon, 10/30/2006 - 5:04pm
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Sorry you had to go through that reaction! From age 3 to age 45, before I had access to any medication and just had to "tough it out" whenever accidentally ingesting peanuts, I experienced multiple symptoms that would occur serially, as the peanut substances moved through my body. First, my mouth and throat would become very sore as if I had swallowed something very acidic, and I would get a lot of saliva. This would last for at least 4-6 hours. About 15 minutes into the reaction, my stomach would begin to hurt and my heart would begin to beat faster. This also would last for 4-6 hours usually, although it differed depending on how much I had ingested. I would vomit after about 2 or 3 hours and after that would feel better for awhile, but after about another half hour my stomach would begin pounding again and I would vomit at least once more. These symptoms would finally subside anywhere from 4 to 8 hours after onset;also, the whites of my eyes would become very red and the next day my eyelids would be swollen. Also, I could feel a burning in my intestines which would finally subside after about 24 hours, as the peanut substance finally passed out of my body. As I got older, hives and asthma appeared along with the initial pain and nausea. Now that I have an epipen with me at all times, it seems that everything goes away within minutes of the shot--hives, asthma, mouth and throat pain, stomach pain. I've never had to have more than one shot. What still remains however is the swelling in my eyelids and redness in the whites of my eyes the next day, and the residual pain in my intestines. Also I feel very sleepy after the shot and am still tired the next day, and I usually get a cold after an attack. My reaction to tree nuts is different and not as awful. It feels as if I have nails in my stomach, and there is pain in my intestines until the last of the nuts pass through my system. I also get hives, but haven't ever used an epipen after having a reaction to tree nuts.

Posted on: Tue, 10/31/2006 - 12:50am
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Could someone please in short explain the differences between all of these reactions you are talking about?? (ie, protracted, biphasic and uniphasic??)
thanks,
Kara

Posted on: Tue, 10/31/2006 - 6:15am
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Kara,
I believe a protracted reaction is one that lasts over an extended period of time. A few days or longer?
A biphasic reaction is what we all have to watch for! After the initial reaction, a second - sometimes worse reaction - can happen a few hours afterwards. I've heard anywhere from 2 - 6 hours.
My allergist told me (and I've also read it here) that if I have a reaction and go to the ER, and I'm released after a few hours, to wait in the hospital waiting room until the danger period has passed.
Uniphasic? I'm guessing it is just the initial reaction, without the second a few hours later.

Posted on: Tue, 10/31/2006 - 12:37pm
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Quote:Originally posted by Adele:
[b]...My allergist told me (and I've also read it here) that if I have a reaction and go to the ER, and I'm released after a few hours, to wait in the hospital waiting room until the danger period has passed...[/b]
And I thought I was the only one hanging out in the ER. LOL Usually stop at the 24 hr Walgreens across the street to pick up a magazine for the wait (mild reactions, of course). One of our area hospitals has wireless. Will have to remember to take my laptop...[i]but crossing fingers that I won't have to![/i]
Take care,
Daisy

Posted on: Sat, 03/31/2007 - 3:15pm
McCobbre's picture
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bumping for Sheryl

Posted on: Sun, 04/01/2007 - 11:49am
cathlina's picture
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My doctors always follow up with a course of predisone after a major reaction.

Posted on: Fri, 09/21/2007 - 2:15am
McCobbre's picture
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Reraising for anyone who might find it helpful.

Posted on: Wed, 10/22/2008 - 1:50pm
McCobbre's picture
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Bumping up.

Posted on: Fri, 08/12/2011 - 11:55am
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Okay, i have a friend whose daughter is severely allergic to a BUNCH of foods. She had a reaction the other day...had to use the epipen. It helped to treat the acute phase, but now, 2 days later, she hasn't been able to eat, only drinks water. Feels her throat tickle and closing when she tries to eat safe foods. Her stomach hurts, and she doesn't tolerate food. She is already thin and losing lots of weight, and seems like she is not coming out if it. I don't know if she needs another epipen, or a course of steroids. She is using benedryl, but her parents are getting pretty worried. She cannot keep going like this. I don't know if it is biphasic or protracted? It seems dangerous to sit on the edge of anaphylaxis and that something needs to happen to help her.

Posted on: Sat, 01/21/2006 - 2:45pm
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I only had to use the epi on dd once. It was for egg and the reaction started somewhere between 1 minute and 10 minutes after eating it. It is hard to remember, because it was 8 years ago. I do remember that I had to give an antihistamine for a few days and a steriod also. It could have been as short as 2 days or as long as 5 days. I really don`t remember. Her reaction was not GI. She had hives, swelling around her eyes, and wheezing. I gave the epi and she was completely fine. However, a few hours later (maybe 2 or 3 hours?) she got a rash. It did not look like hives. It was a different kind of rash. I don`t remember how long it lasted--maybe a day or two? She was otherwise fine, happy, playing, seemed to be feeling fine. Sorry I don`t have more detailed information. Do you think you should call your doctor and ask him if it is typical for you to still be feeling bad this long after?

Posted on: Sun, 01/22/2006 - 12:39am
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Hello McCobbre,
So sorry to hear that you're still feeling lousy. Any reaction I've had has only lasted about 6 hours. I felt tired the next day but not sick.
Is Benedryl helping? If not, is it possible that you are simultaneously came down with something else? It seems logical that you would be more vulnerable to viruses, etc. when you have an allergic reaction - and didn't you go to the hospital? Tons of germs there!
Just a thought....
Hope you feel better.
Adele

Posted on: Sun, 01/22/2006 - 12:53am
momma2boys's picture
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Joined: 03/14/2003 - 09:00

Just raised this for you
[url="http://uumor.pair.com/nutalle2/peanutallergy/Forum1/HTML/004855.html"]http://uumor.pair.com/nutalle2/peanutallergy/Forum1/HTML/004855.html[/url]

Posted on: Sun, 01/22/2006 - 12:58am
Momcat's picture
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Joined: 03/15/2005 - 09:00

Both my kids have required antihistamines for up to a week after a reaction. They get recurrent hives. My son once had to be treated with Zyrtec and Zantac for a month for severe hives (unknown cause--could have been viral or flu shot reaction since he is allergic to eggs).
Cathy
------------------
Mom to 6 1/2 yr old PA/TNA daughter and 3 yr old son who is allergic to eggs.

Posted on: Sun, 01/22/2006 - 11:57am
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Joined: 05/28/2009 - 16:42

I never needed to use the epi, but my DS' recent reaction lasted a total of 10 days. At its worst, he had red spots from head-to-toe, some hives, and big red welts on the palms. I hope you feel better soon!

Posted on: Sun, 01/22/2006 - 12:05pm
TNAmom's picture
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Joined: 11/29/2005 - 09:00

Don't forget that benadryl itself can make people feel weird. Kind of spacey and tired.

Posted on: Sun, 01/22/2006 - 12:10pm
McCobbre's picture
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Momma2boys--thanks for reraising. There were a few posts in there that were especially helpful--the one about abdominal reactions specifically.
Adele--no, I don't think this is a viral thing, because the same three things keep coming back and they disappear after I have Benadryl for a few hours. And I've done enough reading about protracted reactions (different than biphasic reactions) in the last 48 hours to know that they are common enough--and they tend to appear under the same circumstances I had. This morning at church was the last time I had to take Benadryl, so I hope this thing is finished.
And yes--I do plan on talking with my doctor about this.
What's interesting is that I took the epi based on the second symptom appearing (and because it was chest tightness and pain and I'm asthmatic)--and believe I did the right thing. (I must say that I also had a headache the first day, but I'm not sure it was a symptom.) But the truth is, on the subsequent days I had more than one symptom. Indeed, the third appeared 24 hours afterward. If the Epi is given based on the number of symptoms, as I was always told, then I would have needed it on my subsequent days. But clearly I didn't. I just needed Benadryl regularly. I found the Grading of Anaphylaxis thread helpful here and a website or two that helped prioritize.
And it's helpful to see what protracted reactions others have dealt with. Thanks everyone for sharing.

Posted on: Mon, 01/23/2006 - 1:30pm
TJuliebeth's picture
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Joined: 03/30/2005 - 09:00

about 6 years ago, I had an ana. reaction to a medication. I was covered in hives and my face swoll up like a soccer ball. The actual reaction lasted for almost 12 hours until all the med was out of my system. My lips and face were swollen for 4 or 5 days.
here's the weird thing...for over a year afterward all my other allergies and intolerances were worse. I was also incredibly sensitive to odors.
An example is my allergy to cats. I was allergic to cats when I was little, but I had mostly outgrown it. I even had 2 cats for 10 years until my son developed allergies to them. After anaphalaxis, I could not touch a cat without breaking out in hives and having my eyes swell up. Now, 6 years later, I can pet a cat without a reaction as long as I wash my hands. If I get cat hair or dander in my eyes, they will burn, but do not swell anymore.
On the other hand, when my dd experienced ana., she had the sudden onset of symptoms, I gave her the epipen, and she was back to normal within 30 minutes. By the time we got to the ER, you would never have known it happened to look at her...I haven't seen any new allergies or her other allergy getting worse (she is also mildly allergic to cats.)
In any case, I can relate to what you're going through and I hope you will be feeling better soon.

Posted on: Thu, 01/26/2006 - 11:00am
iansmom's picture
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Joined: 07/26/2001 - 09:00

My best friend is anaphylactic to latex, and occasionally has very serious reactions. She has almost died on several occasions, even with immediate use of her EpiPen and prompt medical attention. Whenever she has a serious reaction now, her allergist puts her on steroids for at least a week after to deal with the recurring symptoms. Has anyone else had this kind of treatment for a serious reaction?

Posted on: Sun, 05/21/2006 - 12:35pm
erl's picture
erl
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Joined: 10/06/2001 - 09:00

I've had heightened sensitivity and a kind of protracted anaphylaxis about 3 years ago with 3 epi requiring reactions within 14 days, 2 of which were airborn exposure.
Now I'm 10 days into some sort of the same thing. I had a reaction to shellfish? (which would be a new allergy for me- pn, tn, sesame, chick pea) which I didn't treat with epi but should have. I've been on Prednisone, Zyrtec, Zantac and prn benadryl and albuterol. Today I had a full blown epi requiring reaction to ??airborn outdoors peanut exposure. Hopefully it will settle down.

Posted on: Sun, 05/21/2006 - 10:12pm
GoingNutsMommy's picture
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Joined: 05/16/2006 - 09:00

sorry to hear of your situation. It stands to reason to me that symptoms could last for upwards of a week when they say that the food can stay in your system for that long. This is why when you're on an elimination diet you're supposed to wait anywhere from 3 days to 2 weeks to get it out.
Also, my dd often has a delayed reaction to things -- 4 hrs seems to be the "magic number" for her. Couldn't figure it out for a long time, but, for instance, she will not have an asthma attack while we're at my mom's house (she has a cat, dog and dust), but always 4 hrs after we've visited. But once I give her the medication it doesn't seem to recur from the same incident. Hard to tell. She gets asthma on a regular basis.
Good luck to you.

Posted on: Mon, 05/22/2006 - 12:30am
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Joined: 12/29/2002 - 09:00

My neighbor is allergic to aspirin and she once took Advil and experienced anaphylaxis. She was treated in the ER and they told her that aspirin or Advil reactions can go on for weeks. She experienced symptoms for weeks after that.
So if it happens with aspirin it can happen with shellfish I guess. Hope this helps.
Peg

Posted on: Mon, 10/30/2006 - 12:47pm
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Joined: 01/31/2005 - 09:00

raising for imgm.

Posted on: Mon, 10/30/2006 - 5:04pm
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Joined: 06/08/2006 - 09:00

Sorry you had to go through that reaction! From age 3 to age 45, before I had access to any medication and just had to "tough it out" whenever accidentally ingesting peanuts, I experienced multiple symptoms that would occur serially, as the peanut substances moved through my body. First, my mouth and throat would become very sore as if I had swallowed something very acidic, and I would get a lot of saliva. This would last for at least 4-6 hours. About 15 minutes into the reaction, my stomach would begin to hurt and my heart would begin to beat faster. This also would last for 4-6 hours usually, although it differed depending on how much I had ingested. I would vomit after about 2 or 3 hours and after that would feel better for awhile, but after about another half hour my stomach would begin pounding again and I would vomit at least once more. These symptoms would finally subside anywhere from 4 to 8 hours after onset;also, the whites of my eyes would become very red and the next day my eyelids would be swollen. Also, I could feel a burning in my intestines which would finally subside after about 24 hours, as the peanut substance finally passed out of my body. As I got older, hives and asthma appeared along with the initial pain and nausea. Now that I have an epipen with me at all times, it seems that everything goes away within minutes of the shot--hives, asthma, mouth and throat pain, stomach pain. I've never had to have more than one shot. What still remains however is the swelling in my eyelids and redness in the whites of my eyes the next day, and the residual pain in my intestines. Also I feel very sleepy after the shot and am still tired the next day, and I usually get a cold after an attack. My reaction to tree nuts is different and not as awful. It feels as if I have nails in my stomach, and there is pain in my intestines until the last of the nuts pass through my system. I also get hives, but haven't ever used an epipen after having a reaction to tree nuts.

Posted on: Tue, 10/31/2006 - 12:50am
KaraLH's picture
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Joined: 10/11/2006 - 09:00

Could someone please in short explain the differences between all of these reactions you are talking about?? (ie, protracted, biphasic and uniphasic??)
thanks,
Kara

Posted on: Tue, 10/31/2006 - 6:15am
Adele's picture
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Joined: 01/31/2005 - 09:00

Kara,
I believe a protracted reaction is one that lasts over an extended period of time. A few days or longer?
A biphasic reaction is what we all have to watch for! After the initial reaction, a second - sometimes worse reaction - can happen a few hours afterwards. I've heard anywhere from 2 - 6 hours.
My allergist told me (and I've also read it here) that if I have a reaction and go to the ER, and I'm released after a few hours, to wait in the hospital waiting room until the danger period has passed.
Uniphasic? I'm guessing it is just the initial reaction, without the second a few hours later.

Posted on: Tue, 10/31/2006 - 12:37pm
Daisy's picture
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Joined: 01/16/2006 - 09:00

Quote:Originally posted by Adele:
[b]...My allergist told me (and I've also read it here) that if I have a reaction and go to the ER, and I'm released after a few hours, to wait in the hospital waiting room until the danger period has passed...[/b]
And I thought I was the only one hanging out in the ER. LOL Usually stop at the 24 hr Walgreens across the street to pick up a magazine for the wait (mild reactions, of course). One of our area hospitals has wireless. Will have to remember to take my laptop...[i]but crossing fingers that I won't have to![/i]
Take care,
Daisy

Posted on: Sat, 03/31/2007 - 3:15pm
McCobbre's picture
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bumping for Sheryl

Posted on: Sun, 04/01/2007 - 11:49am
cathlina's picture
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Joined: 06/29/2001 - 09:00

My doctors always follow up with a course of predisone after a major reaction.

Posted on: Fri, 09/21/2007 - 2:15am
McCobbre's picture
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Joined: 04/16/2005 - 09:00

Reraising for anyone who might find it helpful.

Posted on: Wed, 10/22/2008 - 1:50pm
McCobbre's picture
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Joined: 04/16/2005 - 09:00

Bumping up.

Posted on: Fri, 08/12/2011 - 11:55am
allendave1's picture
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Joined: 08/12/2011 - 18:45

Okay, i have a friend whose daughter is severely allergic to a BUNCH of foods. She had a reaction the other day...had to use the epipen. It helped to treat the acute phase, but now, 2 days later, she hasn't been able to eat, only drinks water. Feels her throat tickle and closing when she tries to eat safe foods. Her stomach hurts, and she doesn't tolerate food. She is already thin and losing lots of weight, and seems like she is not coming out if it. I don't know if she needs another epipen, or a course of steroids. She is using benedryl, but her parents are getting pretty worried. She cannot keep going like this. I don't know if it is biphasic or protracted? It seems dangerous to sit on the edge of anaphylaxis and that something needs to happen to help her.

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Food Allergen Labeling and Consumer Protection Act (FALCPA)

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