Delayed Epinephrine Administration and Biphasic Anaphylaxis: A Case Report

Introduction: Anaphylaxis is a potentially life-threatening, acute systemic hypersensitivity reaction, which usually represents an Ig-E mediated allergy. Bee sting may induce anaphylaxis reaction, with near fatal and fatal outcomes. Epinephrine, the essential first line in the treatment of anaphylaxis, is some of the time not administered. Delayed epinephrine administration played a role as prognostic factor in anaphylaxis that can contribute to the occurrence of biphasic reaction. Here we report a case of delayed epinephrine administration and biphasic anaphylaxis. Case Report: Female, 26 year-old, came to hospital with complain of itchiness, reddish, swelling locally and numb in the left hand, worsen palpitation and tachypnea 10 hours after stung by bee. She has no history of allergic disease. She was given epinephrine 0.3 ml intramuscularly, with other adjuvant therapy. The symptoms were getting better after 10 minutes administration of epinephrine. Discussion: Symptoms in the patient met the Sampson criteria for anaphylaxis and is classified into moderate reaction based on Brown criteria. In this case, there was a delayed epinephrine administration which may be related to the development of biphasic anaphylaxis. Conclusion: Delayed epinephrine administration is associated with increase morbidity and mortality from anaphylaxis.