Such reactions may appear as edema or inflammation at the injection site or cause a variety of manifestations elsewhere, such as redness of the skin, itching, conjunctivitis, rhinitis, swelling of the face (angioedema), the upper or (and) lower lip, cheeks, vocal cords, pharynx accompanied by difficulty of breathing or swallowing, urticaria, severe dyspnea, which may progress to anaphylactic shock.

Should there be a comma before "accompanied by"?

The Russian original uses "with" instead of "accompanied by", but I thought that might mean like "pharynx with difficulties of breathing", so I used "accompanied".

I think that if there was a full stop after "swallowing", a comma would have been okay; but with the list continuing, it might be better without one.

  • 2
    It's a parenthetic in this context, but more commas would be confusing. So I'd use parentheses: "... the pharynx (accompanied by difficulty breathing or swallowing), urticaria..."
    – TimR
    Jun 18, 2016 at 12:45
  • The sub-list is a list of swelling sites, governed by of.
    – TimR
    Jun 18, 2016 at 12:48
  • No, a semicolon before pharynx would not do, since pharynx is one of the objects of preposition of in swelling of...
    – TimR
    Jun 18, 2016 at 14:17

1 Answer 1


A comma after "pharynx" is not necessary is "accompanied" is not part of the list of body parts, but usually there would be an "or" before "pharynx"

swelling of the face (angioedema), the upper or (and) lower lip, cheeks, vocal cords, or pharynx accompanied by difficulty of

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