WAO Allergy Quiz
Check Your AQ (Allergy Quotient)
Edited by Glenis Scadding, MD
Posted 08 January 2014
MS, male 34 years, was brought to the Emergency department. Fifteen minutes before, while walking in the street, he received a bee-sting. Very quickly he had palmo-plantar pruritus with ongoing skin red eruptions with intense pruritus, a dry cough with aphonia, stuffy nose and pruritus in nose and throat. He was taken to a nearby hospital where a diagnosis of anaphylaxis was made in ED. Pulse rate was 110/minute, blood pressure 90/50, O2 saturation was 92%. No other abnormalities were found.
Patient immediately was laid down in recumbent position; epinephrine via auto injector was administered on the external surface of the left thigh, and followed with a serum intravenous infusion with diphenhydramine ("Benadryl") 10 mgs and metilprednisolone 500 mgs. Blood was obtained for tryptase levels and specific IgE to bee venom.
A favorable response is promptly registered, the urticaria began to fad, the patient became able to speak, and 45 minutes later his blood pressure was 120/70, O2 saturation 98%, pulse rate 85/minute with no other abnormalities noted. One hour later the patient is feeling well. His urticaria has disappeared and the lip angioedema was clearly much smaller. The blood pressure was stable and the rest of the clinical examination is normal. Fifteen minutes later, after 2 hours in the ED, the patient was discharged with instructions to see a specialist for treatment of bee-venom allergy.
Which of the procedures made in this clinical case, (a real one), was wrong or absent?