{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T05:31:14Z","timestamp":1737610274006,"version":"3.33.0"},"reference-count":0,"publisher":"California Digital Library (CDL)","issue":"1","license":[{"start":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T00:00:00Z","timestamp":1730160000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Western Journal of Emergency Medicine"],"abstract":"<p>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\u20136 hours post-treatment. We analyzed the rate and timing of BPR, comparing the intervals of 0\u20134vs4\u201348 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 \u22652 additional doses]. All BPR episodes occurred within the 0\u20134 hour interval after initiating therapy, whereas no patient manifested a BPR requiring an additional dose of IM EPI during the 4\u201348 hours after initiating therapy (P =&amp;lt;0.001, 95% CI 0\u20131.3%). 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 signi\ufb01cantly lower &amp;gt;4 hours vs &amp;lt;4 hours after initiating therapy.<\/p>","DOI":"10.5811\/westjem.18555","type":"journal-article","created":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T20:33:37Z","timestamp":1730234017000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of Treatment on Rate of Biphasic Reaction in Children with Anaphylaxis"],"prefix":"10.5811","volume":"26","author":[{"given":"William","family":"Bonadio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Connor","family":"Welsh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brad","family":"Pradarelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunfai","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2024,10,29]]},"container-title":["Western Journal of Emergency Medicine"],"original-title":[],"link":[{"URL":"https:\/\/escholarship.org\/content\/qt7jj04687\/qt7jj04687.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T19:52:31Z","timestamp":1737575551000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/7jj04687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,29]]},"references-count":0,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,16]]}},"URL":"https:\/\/doi.org\/10.5811\/westjem.18555","relation":{},"ISSN":["1936-9018"],"issn-type":[{"type":"electronic","value":"1936-9018"}],"subject":[],"published":{"date-parts":[[2024,10,29]]}}}