Biphasic Anaphylaxis

The late phase response, as noted, refers to the recrudescence of symptoms after an apparent temporary resolution. Such patients are said to experience biphasic anaphylaxis. Biphasic anaphylaxis is recurrent anaphylaxis occurring 1 to 72 hours after resolution of an initial anaphylactic episode, though an outside limit of 78 hours has also been suggested. Estimates of biphasic anaphylaxis vary from <1% to 20% of patients; These recurrences can occur repeatedly after multiple temporary remissions.  Delayed epinephrine administration is also associated with an increased risk of developing a biphasic reaction, i.e., worsening symptoms after a period of improvement.

Biphasic anaphylaxis is associated with;

  • a more severe initial presentation of anaphylaxis (odds ratio [OR], 2.11; 95% CI, 1.23-3.61) or
  • repeated epinephrine doses (i.e., >1 dose of epinephrine) required with the initial presentation (OR, 4.82; 95% CI, 2.70-8.58)
  • wide pulse pressure (OR, 2.11; 95% CI, 1.32-3.37),
  • unknown anaphylaxis trigger (OR, 1.63; 95% CI, 1.14-2.33),
  • cutaneous signs and symptoms (OR, 2.54; 95% CI, 1.25-5.15), and
  • drug trigger in children (OR, 2.35; 95% CI, 1.16-4.76)

Prompt and adequate treatment of anaphylaxis appears central to reducing biphasic anaphylaxis risk. While the possibility of biphasic anaphylaxis should be emphasized in this higher risk group, it is important to educate all patients regarding the chance of a biphasic reaction as well as avoiding known triggers, identification of symptoms of anaphylaxis, the use of auto-injector epinephrine for the treatment of anaphylaxis, and timely follow-up with an allergist.

2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)

The 2020 Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) are a comprehensive revision of the AHA’s guidelines for adult, pediatric, neonatal, resuscitation education science, and systems of care topics. They have been developed for resuscitation providers and AHA instructors to focus on the resuscitation science and guidelines recommendations that are most significant or controversial, or those that will result in changes in resuscitation training and practice, and to provide the rationale for the recommendations.

Highlights 

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Kenya Emergency Medical Care Policy 2020-2030

Dr Mercy Mwangangi, the Chief Administrative Secretary (CAS), Ministry of Health at the opening of the 5th African Conference on Emergency Medicine (#AfCEM20) in Nairobi, Kenya

The Kenya Emergency Medical Care (EMC) Policy 2020-2030 is the first-ever policy in Kenya that seeks to establish a working Emergency Medical Care (EMC) System as a key component of the healthcare system in the country. The policy also speaks to the World Health Assembly resolution WHA 72.16 of 21 May 2019 which urged member states to create policies for sustainable funding, effective governance and universal access to safe, high-quality, needs-based emergency care for all as part of universal health coverage. In developing this policy, the Ministry of Health (MOH) aims to ensure access to the highest standards of emergency medical care in Kenya as envisioned in The Constitution of Kenya (2010) and the Health Act (2017) which guarantees every Kenyan the right to emergency medical treatment.

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Dr Mercy Mwangangi opens African Emergency Medicine Conference in Nairobi, Kenya

“On behalf of the Government of Kenya and the Ministry of Health, I would like to welcome you all to the 5th African Conference on Emergency Medicine being streamed live from Nairobi, Kenya.” Dr Mercy Mwangangi, Cabinet Administrative Secretary, Ministry of Health Kenya

Hands-Only CPR

If you see a teen or adult suddenly collapse, hands-only CPR is the recommended form of cardiopulmonary resuscitation (CPR). It not only increases the likelihood of surviving breathing and cardiac emergencies that occur outside of medical settings, but it’s simple to learn and easy to remember. For a refresher any time, you can print up this page and keep it with the rest of your first-aid supplies.