Characteristics of uniphasic and biphasic anaphylaxis in infants and young toddlers: An analysis of clinical…

Cohort studyPediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology· Aug 2026

Characteristics of uniphasic and biphasic anaphylaxis in infants and young toddlers: An analysis of clinical signs, predictors and management.

Kristina Rueter, Brennan Ta, Natasha Bear … Susan L Prescott

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Allergy & ImmunologyCohort studyQ1IF 3.0

Biphasic reactions occurred in 4.6% of infant/toddler anaphylaxis cases, all food-induced

Characteristics of uniphasic and biphasic anaphylaxis in infants and young toddlers: An analysis of clinical signs, predictors and management.

Kristina Rueter … Susan L Prescott

Pediatric allergy and immunology · Aug 2026 · Q1 in Pediatrics

Background

Rates of anaphylaxis in early childhood are rising, yet there remains a paucity of data on age-specific presentations and outcomes.

Purpose

To characterize symptoms of anaphylaxis in infants and toddlers, analyze predictors for biphasic anaphylaxis and get more insight into required observation times in this age group.

Methods

We analyzed clinical features, allergens, and management, comparing uniphasic and biphasic presentations.

n = 243 cases

4.6%

Results

4.6%

About 1 in 22 infants with anaphylaxis had a second reaction after initial recovery

n = 243 cases

More results

Symptoms included urticaria (85.8%), angioedema (67.8%), wheeze/persistent cough (57.7%), vomiting (42.3%) and flushing (21.8%).

Symptoms unique to infants/toddlers were pallor/hypotonia (33.5%) and persistent crying (13.8%).

More results

Predictors for biphasic anaphylaxis were lower systolic blood pressure (p = .011), pallor/hypotonia (p = .046), use of fluids (p < .001), and greater severity (p = .014).

Timeframe for recurrence of anaphylaxis was 70-330 min.

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Conclusion · 1 of 2

Increased awareness of age-specific symptoms is essential for timely recognition and optimal care of infant/young toddler anaphylaxis.

Conclusion · 2 of 2

Cardiovascular signs, fluid resuscitation, and reaction severity may help predict recurrent anaphylaxis in 0-2-year-olds and identify which patients need observation beyond 4 h versus those safe for earlier discharge.

Characteristics of uniphasic and biphasic anaphylaxis in infants and young toddlers: An analysis of clinical signs, predictors and management.

Characteristics of uniphasic and biphasic anaphylaxis in infants and young toddlers: An analysis of clinical signs, predictors and management.

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