Review ArticleMedicolegal Implications of Biphasic AnaphylaxisDa Broi, Ugo MD, PhD∗; Moreschi, Carlo MD∗; Marega, Giulia MD∗; Tse, Rexson BSc MBBS MD†,‡; Garland, Jack B.Med§; Ondruschka, Benjamin MD∥; Palmiere, Cristian MD¶Author Information From the ∗Department of Medicine, Forensic Medicine, University of Udine, Udine, Italy †School of Medicine, Faculty of Medical and Health Sciences, University of Auckland ‡Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand §Forensic and Analytical Science Service, NSW Health Pathology, New South Wales, Australia ∥Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ¶CURML, University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland. Manuscript received June 24, 2020; accepted August 25, 2020. The authors report no conflict of interest. Reprints: Ugo Da Broi, Section of Forensic Medicine, Department of Medicine, University of Udine, Piazzale S. Maria della Misericordia 15, Udine, Italy. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: June 2021 - Volume 42 - Issue 2 - p 109-117 doi: 10.1097/PAF.0000000000000621 Buy Metrics Abstract Biphasic anaphylaxis is an uncommon IgE-mediated condition whose pathophysiological mechanisms, risk factors, and predictive signs are not properly understood. Fortunately, the lethality of biphasic anaphylaxis, although probably underestimated, is low. Preventive clinical measures for biphasic anaphylaxis are neither standardized nor commonly applied. Furthermore, there are no laboratory protocols or anaphylactic markers to help identify the onset of biphasic anaphylaxis in clinical settings. The aim of this review is to highlight the medicolegal difficulties facing coroners and forensic pathologists in terms of the diagnosis and assessment of harm for victims and survivors of biphasic anaphylaxis. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.