Risk Factors and Characteristics of Biphasic Anaphylaxis

Kraft, Magdalena; Scherer, Kathrin; Ruëff, Franziska; Pföhler, Claudia; Renaudin, Jean‐Marie; Bilò, Maria Beatrice; Treudler, Regina; Lang, Roland; Cichocka‐Jarosz, Ewa; Fernández‐Rivas, Montserrat; Christoff, George; Papadopoulos, Nikolaos G.; Ensina, Luis Felipe; Hourihane, Jonathan; Maris, Ioana; Koehli, Alice; García, Blanca E.; Jappe, Uta; Vogelberg, Christian; Ott, Hagen; Lange, Lars; Spindler, Thomas; Dölle‐Bierke, Sabine; Worm, Margitta

doi:10.1016/j.jaip.2020.07.036

Cited by 44 publications

(55 citation statements)

References 35 publications

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“…33 A rate of 4.7% has been reported in the European Anaphylaxis Registry. 34 In a prospective case series of anaphylaxis presenting to Emergency Departments, delayed deteriorations were noted in 17% (55/315) of reactions, of which 29 (9.2%) required treatment with adrenaline. 76 Contradictory ranges for the onset of biphasic symptoms are reported in the literature.…”

Section: Rationalementioning

confidence: 99%

“…33 This is consistent with data from the European Anaphylaxis Registry (7328 patients, 5% rate of biphasic reactions; OR 0.91, 95% CI 0.71À1.16). 34 The EAACI 2020 systematic review reported two relevant case-control studies, but could not comment on whether adrenaline prevents biphasic anaphylactic reactions because the certainty of evidence was very low. 23 What is the optimal timing of adrenaline in the treatment of anaphylaxis?…”

Section: For Policy Makersmentioning

confidence: 99%

“…33 In the European Anaphylaxis Registry, one third of biphasic reactions occurred more than 12 h after initial symptoms. 34 The optimal duration of observation following anaphylaxis is unknown. The previous RCUK guideline recommended patients should be observed for at least 6 h, 5 on the basis of data from the UK Fatal Anaphylaxis Register which found that in cases reported to 2000, death never occurred more than 6 h after contact with the trigger.…”

Section: Rationalementioning

confidence: 99%

“…11 The published literature clearly indicates that this strategy will miss over 50% of biphasic reactions. 33,34,76 NICE recommends that patients under 16 years should be admitted to hospital under a paediatric team to ensure that "children and their parents or carers . .…”

Section: Rationalementioning

confidence: 99%

“…69 Antihistamines do not reduce the occurrence of biphasic reactions. 16 , 33 An analysis of 9171 anaphylaxis episodes reported to the European Anaphylaxis Register found that antihistamine treatment was significantly associated with the occurrence of biphasic reactions (OR 1.52, 95% CI 1.14–2.02); 34 this may be due to antihistamine use delaying adrenaline administration. We therefore recommend against antihistamines for the acute management of anaphylaxis (weak recommendation); this in consistent with the ASCIA 2020 Guideline.…”

Section: Introductionmentioning

confidence: 99%

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Evidence update for the treatment of anaphylaxis

et al. 2021

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The Resuscitation Council UK has updated its Guideline for healthcare providers on the Emergency treatment of anaphylaxis. As part of this process, an evidence review was undertaken by the Guideline Working Group, using an internationally-accepted approach for adoption, adaptation, and de novo guideline development based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence to decision (EtD) framework, referred to as GRADE-ADOLOPMENT. A number of significant changes have been made, which will be reflected in the updated Guideline.These include: emphasis on repeating intramuscular adrenaline doses after 5 min if symptoms of anaphylaxis do not resolve; corticosteroids (e.g. hydrocortisone) no longer being routinely recommended for the emergency treatment of anaphylaxis; interventions for reactions which are refractory to initial treatment with adrenaline; a recommendation against the use of antihistamines for the acute management of anaphylaxis; and guidance relating to the duration of observation following anaphylaxis, and timing of discharge.

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Section: Rationalementioning

confidence: 99%

Section: For Policy Makersmentioning

confidence: 99%

Section: Rationalementioning

confidence: 99%

Section: Rationalementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence update for the treatment of anaphylaxis

et al. 2021

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Comparison of the efficacy of continuous intravenous infusion versus intramuscular injection of epinephrine for initial anaphylaxis treatment

Fujizuka

Nakamura

Tamura

et al. 2022

Acute Medicine & Surgery

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Aim Continuous intravenous (CIV) infusion of epinephrine for the treatment of anaphylaxis may be required if symptoms do not improve after intramuscular (IM) injection. As CIV infusion permits precise dose adjustment, we compared treatment course and adverse events following CIV infusion and IM injection of epinephrine for the management of anaphylaxis. Methods Medical records of patients, who were treated for anaphylaxis with epinephrine, were 18 years or older, and were admitted to our department from April 2005 to March 2016, were retrospectively reviewed. The cases were categorized as CIV infusion or IM injection, and treatment course and outcomes were compared between the two groups. Results Of the 142 eligible cases, there were 78 in the CIV infusion group and 64 in the IM injection group. The CIV infusion group had lower systolic blood pressure, more respiratory symptoms, and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, but required a lower total dose of epinephrine, had fewer adverse events after epinephrine administration, and showed lower incidence of biphasic reactions. In addition, compared with the IM injection group, time to administration of epinephrine was significantly longer ( P < 0.001), but time to resolution of symptoms, both from contact and epinephrine administration, was significantly shorter ( P < 0.01 and P = 0.03, respectively). Conclusion Continuous intravenous infusion of epinephrine for the treatment of anaphylaxis may be safe, has fewer adverse events, improves symptoms, and is relatively easy to administer under ready conditions. CIV infusion of epinephrine may also reduce the incidence of biphasic reactions.

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