⚠️ Disclaimer: This article is for informational purposes only and does not replace medical advice. If you have any health concerns or emergencies, please contact a doctor or call emergency services (112 or 911).
It was the perfect summer day. Our annual summer party was in full swing – sunshine, happy neighbors, and good vibes all around. Close friends were also there, including a couple we had been pregnant alongside. Our children were the same age, and the day felt carefree.
They brought along fruit bars – a seemingly harmless snack. My husband, always cautious, checked the ingredient list and asked me to double-check. I looked at it too and gave my approval. We all knew about our daughter's allergies, but in that moment, we were too relaxed. We completely overlooked the almonds – tree nuts – in the snack.
And then it happened. First, a slight scratchy throat, then redness, swelling – and finally, difficulty breathing.
We had been through a reaction before – that time, without an EpiPen. Luckily, this time we had Rectodelt at home, so we administered it immediately and called the paramedics.
🚑 Flashing lights, the hospital, the first use of an EpiPen. A nightmare.
But it wasn’t over yet.
Thirty minutes later, in the hospital room – round two, all over again. The emergency team had already warned us that this could happen. We experienced our first biphasic anaphylaxis, something we had never even heard of before.
In this article, I’ll explain what biphasic anaphylaxis is, why it occurs, and how to protect against it.
A biphasic anaphylaxis means that symptoms do not occur just once but in two waves.
After the first allergic reaction – which may include breathing difficulties, hives, or circulatory issues – the person seems to recover.
However, hours later – sometimes up to 72 hours afterward – another anaphylactic reaction occurs, even though no additional allergen has been ingested.
The second reaction can be just as severe or even worse than the first. This makes it particularly dangerous, especially if the person has already been discharged from medical care and is in an environment without access to emergency medication.
Not every anaphylaxis results in a second reaction. The risk varies from person to person and depends on factors like the severity of the first reaction, the treatment given, and how the immune system responds.
The exact causes of biphasic anaphylaxis are not yet fully understood, but several mechanisms are known to play a role:
1️⃣ Delayed release of inflammatory chemicals – Even after the allergen is gone, the immune system can remain active, leading to a second reaction.
2️⃣ Insufficient initial treatment – If not enough epinephrine or other medication is given, the immune system may trigger a second wave of symptoms.
3️⃣ Individual risk factors – Some individuals, especially children with severe allergies, have a higher risk of biphasic reactions.
For us as parents, it was a huge shock to learn that a second reaction could even occur.
Only through discussions with doctors and research did we understand how crucial extended medical observation is after an anaphylaxis episode.
The best way to minimize the risk of a biphasic reaction is to be well-prepared and to follow the correct protocol after the initial allergic reaction:
🚑 Correct Emergency Response Sequence:
1️⃣ Immediately administer the epinephrine auto-injector (e.g., EpiPen) into the thigh muscle.
2️⃣ Call emergency services (112/911) – clearly state “Anaphylaxis emergency!”
3️⃣ Lay the person down (unless they are struggling to breathe – in that case, keep them sitting up).
4️⃣ Give antihistamines & corticosteroids (if prescribed).
5️⃣ Stay at the hospital for at least 6–12 hours for monitoring.
💡 If a second dose of epinephrine is needed, it can be administered after 5 minutes.
We always carry two EpiPens – one current and one from the previous year, as they expire annually.
✅ Always stay under medical supervision: Even if symptoms improve after epinephrine, the affected person should be monitored in the hospital for at least 6–12 hours, sometimes longer.
✅ Educate those around you: Caregivers, teachers, and friends should be aware that a biphasic reaction is possible.
✅ Use a well-organized emergency bag:
That’s why we developed ANA AID – a specialized emergency bag designed for these situations, keeping all critical medications easily accessible.
Biphasic anaphylaxis can be particularly dangerous because it occurs just when you think the crisis is over.
Being aware of this possibility can save lives.
🛑 Do you want to be the first to know when the ANA AID emergency bag becomes available?
➡ Sign up now for the exclusive pre-order! diana@ana-aid.de
📩 Would you like to support our project or have suggestions? Feel free to send me an email at diana@ana-aid.de