Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis
Objective: Our goal was to characterize a large group of children presenting to the emergency department (ED) with acute anaphylaxis, treated with intramuscular epinephrine (IM EPI) and a corticosteroid (CS), and to determine the impact of pharmacologic intervention on the rate and timing of biphasi...
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2024-10-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/7jj04687 |
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| _version_ | 1825201953713422336 |
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| author | William Bonadio Connor Welsh Brad Pradarelli Yunfai Ng |
| author_facet | William Bonadio Connor Welsh Brad Pradarelli Yunfai Ng |
| author_sort | William Bonadio |
| collection | DOAJ |
| description | Objective: Our goal was to characterize a large group of children presenting to the emergency department (ED) with acute anaphylaxis, treated with intramuscular epinephrine (IM EPI) and a corticosteroid (CS), and to determine the impact of pharmacologic intervention on the rate and timing of biphasic reactions (BPR). Methods: We reviewed consecutive children diagnosed with acute anaphylaxis managed in three EDs during a six-year period. All received IM EPI and CS, followed by monitoring for 4–6 hours post-treatment. We analyzed the rate and timing of BPR, comparing the intervals of 0–4 vs 4–48 hours after initiating therapy. Results: During the study period, there were 371 cases of anaphylaxis, of which 357 (94%) received both IM EPI and CS. Of these, 49 (14%) manifested BPR [84% had received prehospital IM EPI] requiring at least one additional dose of IM EPI [14% required ≥2 additional doses]. All BPR episodes occurred within the 0–4 hour interval after initiating therapy, whereas no patient manifested a BPR requiring an additional dose of IM EPI during the 4–48 hours after initiating therapy (P = <0.001, 95% CI 0–1.3%). No patient returned to the ED with recurrence of anaphylaxis symptoms within 48 hours after discharge. Conclusion: Approximately 1 in 7 children with anaphylaxis experience a biphasic reaction after receiving intramuscular epinephrine. Children with anaphylaxis who exhibit symptomatic resolution four hours following initiation of therapy have a low risk for subsequently developing BPR. Most BPR cases required only one additional dose of IM EPI to effect resolution. The rate of BPR in those receiving IM EPI and a corticosteroid is significantly lower >4 hours vs <4 hours after initiating therapy. |
| format | Article |
| id | doaj-art-e439849f95c249ae9714da11e1cb9729 |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-e439849f95c249ae9714da11e1cb97292025-02-07T16:29:04ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182024-10-0126117117510.5811/westjem.1855518555Impact of Treatment on Rate of Biphasic Reaction in Children with AnaphylaxisWilliam Bonadio0Connor Welsh1Brad Pradarelli2Yunfai Ng3Mount Sinai Morningside Medical Center, New York, New YorkMount Sinai Morningside Medical Center, New York, New YorkMount Sinai Morningside Medical Center, New York, New YorkMount Sinai Morningside Medical Center, New York, New YorkObjective: Our goal was to characterize a large group of children presenting to the emergency department (ED) with acute anaphylaxis, treated with intramuscular epinephrine (IM EPI) and a corticosteroid (CS), and to determine the impact of pharmacologic intervention on the rate and timing of biphasic reactions (BPR). Methods: We reviewed consecutive children diagnosed with acute anaphylaxis managed in three EDs during a six-year period. All received IM EPI and CS, followed by monitoring for 4–6 hours post-treatment. We analyzed the rate and timing of BPR, comparing the intervals of 0–4 vs 4–48 hours after initiating therapy. Results: During the study period, there were 371 cases of anaphylaxis, of which 357 (94%) received both IM EPI and CS. Of these, 49 (14%) manifested BPR [84% had received prehospital IM EPI] requiring at least one additional dose of IM EPI [14% required ≥2 additional doses]. All BPR episodes occurred within the 0–4 hour interval after initiating therapy, whereas no patient manifested a BPR requiring an additional dose of IM EPI during the 4–48 hours after initiating therapy (P = <0.001, 95% CI 0–1.3%). No patient returned to the ED with recurrence of anaphylaxis symptoms within 48 hours after discharge. Conclusion: Approximately 1 in 7 children with anaphylaxis experience a biphasic reaction after receiving intramuscular epinephrine. Children with anaphylaxis who exhibit symptomatic resolution four hours following initiation of therapy have a low risk for subsequently developing BPR. Most BPR cases required only one additional dose of IM EPI to effect resolution. The rate of BPR in those receiving IM EPI and a corticosteroid is significantly lower >4 hours vs <4 hours after initiating therapy.https://escholarship.org/uc/item/7jj04687 |
| spellingShingle | William Bonadio Connor Welsh Brad Pradarelli Yunfai Ng Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis Western Journal of Emergency Medicine |
| title | Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis |
| title_full | Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis |
| title_fullStr | Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis |
| title_full_unstemmed | Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis |
| title_short | Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis |
| title_sort | impact of treatment on rate of biphasic reaction in children with anaphylaxis |
| url | https://escholarship.org/uc/item/7jj04687 |
| work_keys_str_mv | AT williambonadio impactoftreatmentonrateofbiphasicreactioninchildrenwithanaphylaxis AT connorwelsh impactoftreatmentonrateofbiphasicreactioninchildrenwithanaphylaxis AT bradpradarelli impactoftreatmentonrateofbiphasicreactioninchildrenwithanaphylaxis AT yunfaing impactoftreatmentonrateofbiphasicreactioninchildrenwithanaphylaxis |