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WAO Allergy Quiz

Check Your AQ (Allergy Quotient)

Edited by Glenis Scadding, MD

This month's quiz question was contributed by Juan Francisco Schuhl, MD

Posted 10 September 2012

A male of 34 years receives a bee sting, walking down the street. Very quickly he has palmo-plantar pruritus with ongoing skin red eruptions with intense pruritus, a dry cough with aphonia, stuffy nose and pruritus in nose and throat. At a nearby hospital ED, he receives a diagnosis of generalized urticaria with angioedema of upper lips. During clinical examination his pulse rate was 110/minute, blood pressure 90/50, digital O2 saturation was 92%, and no other abnormalities were remarked. He is immediately placed in a recumbent position and administered epinephrine with autoinjector on the external surface of the left thigh, followed by a serum intravenous infusion with diphenhydramine ("Benadryl") 10 mgs and metilprednisolone 500 mgs. The patient's blood was obtained for tryptase levels and specific IgE to bee venom.

A favorable response is promptly registered. Urticaria starts fading, the patient is again able to speak, and 45 minutes later his blood pressure is 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 is clearly much smaller. Blood pressure remains the same and the rest of the clinical examination is normal. Fifteen minutes later, after 2 hours in the ED, the patient is discharged with instructions to see a specialist for treatment of bee-venom allergy and oral antihistamines in the event of a similar situation.

Which one of the procedures made in this clinical case was wrong or absent?

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