Podcast #226: Biphasic Anaphylaxis - The Emergency Medical Minute

Author: Sam Killian, M.D.

Educational Pearls

  • Anaphylaxis is common in the ED. These patients are treated and then usually watched for 4-6 hours.
  • Biphasic happens in patients that have a complete resolution of their anaphylaxis  for at least an hour, but then have a recurrence that requires pharmacologic  intervention. Most of the time this happens 3-6 hours later, but can happen more than 10 hours later.
  • More commonly happens in patients that have a delayed presentation,  a wide pulse pressure, need multiple doses of epi, require the use of  a beta agonist, or are ages 6-9 years old.
  • Educate patients about the possibility of Biphasic anaphylaxis before discharge. 

References: http://www.medscape.org/viewarticle/583328_7


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