Objective Anaphylaxis is a condition that warrants an observation period after symptoms resolution to detect rare but life-threatening delayed complications. There is a need for evidence to identify patients who would benefit from prolonged observation time. The purpose of this review was to identify factors that may influence the need for longer observation in the emergency department. Methods PubMed, Embase, EBM Review, and Cochrane Library were searched using controlled vocabulary and keywords to cover all relevant data. Titles, abstract, and full text were reviewed for inclusion and exclusion criteria. Data were extracted from the included articles regarding case definitions, prognosis, treatment and time factors, and recommended observation time. Factors linked to observation time or complications were tabulated and compared between studies.
ResultsThe search retrieved 2443 citations of which 49 were included. Twenty-one were primary studies and were used to identify factors influencing observation time or complications. Biphasic anaphylaxis was the only adverse event that warranted prolonged observation. The five risk factors often associated with biphasic reactions were time to first epinephrine, history of anaphylaxis, symptom severity, number of epinephrine doses, and unknown trigger. Biphasic reactions happened mostly within the first 72 h with most severe reactions occurring earlier than the milder ones. Heterogeneity in the definition of biphasic anaphylaxis made comparisons challenging. Conclusions Observation time should be based on the provider's best estimation of the risk of biphasic anaphylaxis, although no single factor can predict their occurrence. The identified factors will allow the development of an early discharge screening tool.
When in 2007 it became clear that the Karger journal Community Genetics would change its name and scope, the first author started to establish an international, multidisciplinary e-mail network and a newsletter with papers authored by the members of the network. This paper reports on the first 3 years of the network. At the end of the 3-year period, there were 858 members, 50 newsletters had appeared, and almost 1,500 different papers from 458 journals had been cited. This model may serve as an example for others who want to bring together those sharing a common interest.
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