Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020 Apr;145(4):1082-1123. doi: 10.1016/j.jaci.2020.01.017. Epub 2020 Jan 28.

Anaphylaxis Algorith TREKK 2018, rev dec 2020

Anaphylaxis Pediatric Packages (PedsPacs), TREKK

Anaphylaxie après la vaccination en milieu communautaire : aide visuelle pour le diagnostic et la prise en charge, Agence de la santé publique du Canada, sept 2023

Caractéristiques distinctives de l'ANAPHYLAXIE, Agence de la santé publique du Canada, 2023

Dose d’ÉPINÉPHrine par voie intramusculaire (solution de 1:1000, 1 mg/ml), selon l’âge ou le poids, Agence de la santé publique du Canada, 2023

Le traitement d’urgence de l’anaphylaxie chez les nourrissons et les enfants, Affichage : le 1 janvier 2011  Reconduit :le 28 février 2018

Réaction Biphasique:

Biphasic anaphylaxis: A review of the literature and implications for emergency management. Pourmand A, Robinson C, Syed W, Mazer-Amirshahi M. Am J Emerg Med. 2018 Aug;36(8):1480-1485. doi: 10.1016/j.ajem.2018.05.009. Epub 2018 May 9. PMID: 29759531.
Conclusions: There is a need for further research to identify true risk factors associated with biphasic anaphylaxis and to clearly define the role of corticosteroids in biphasic reactions. However, given the low incidence and rare mortality of biphasic reactions, patients who receive epinephrine within one hour of symptom onset and who respond to epinephrine with rapid and complete symptom resolution can probably be discharged from the ED with careful return precautions and education without the need for prolonged observation.

Biphasic anaphylaxis: a systematic review of the literature. Mack, D.P. All Asth Clin Immun 10 (Suppl 1), A5 (2014).
Overall frequency of biphasic reactions was 7.36% of anaphylactic reactions with prospective studies reporting a frequency of 9.07%. Mean time to the second phase of BA was 8.13 hours (95% CI, 6.13-10.14) with similar times between both pediatric and adult populations. The range of reported times to onset of the second phase of biphasic reactions was 1 – 72 hours
Conclusions: Biphasic reactions are common presentations of anaphylaxis with both pediatric and adult patients being affected. Mean and median times to onset of the second phase are variable, but are longer than most emergency department observation time recommendations. Carefully designed prospective studies with clear definitions of BA are necessary to accurately determine the characteristics of these life-threatening reactions.

Biphasic anaphylactic reactions: occurrence and mortality. Rohacek M, Edenhofer H, Bircher A, Bingisser R. Allergy. 2014 Jun;69(6):791-7. doi: 10.1111/all.12404. Epub 2014 Apr 12. PMID: 24725226.
Conclusion: Biphasic anaphylactic reactions, especially clinically important ones, occurred rarely, and no mortality was found, whether the monitoring was for ≥8 h or for <8 h. Our study could motivate physicians to consider discharging patients after complete resolution of an anaphylactic reaction and to dispense with prolonged monitoring.

Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis. Grunau BE, Li J, Yi TW, Stenstrom R, Grafstein E, Wiens MO, Schellenberg RR, Scheuermeyer FX. Ann Emerg Med. 2014 Jun;63(6):736-44.e2. doi: 10.1016/j.annemergmed.2013.10.017. Epub 2013 Nov 13. PMID: 24239340.
Conclusion: Among ED patients with allergic reactions or anaphylaxis, clinically important biphasic reactions and fatalities are rare. Our data suggest that prolonged routine monitoring of patients whose symptoms have resolved is likely unnecessary for patient safety.