MD: Mind Dump

This is a blog about anything and everything this MD is thinking about; from academic medical information to hobbies and activities outside the healthcare field.

Anaphylaxis or not?

A few days back, I have encountered two cases of hypersensitivity reaction. Here is case number 1:

A 26-year old female, with a known allergy to Salbutamol, minutes after having eaten fried milkfish for breakfast, had a feeling of warmth and appeared red all over. She also started having difficulty breathing, thus prompting her to go to the emergency room.

Upon ER consult, she was tachycardic with a heart rate of around 140s but she was normotensive and normothermic. Respiratory rate was less than 30.

I could not yet remember what the criteria for diagnosing anaphylaxis were, and I had to review it… So, I just looked up the World Allergy Organization guidelines for the assessment of anaphylaxis. The clinical criteria are any one of the following:

  1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized urticaria, itching or flushing, swollen lips-tongue-uvula); AND AT LEAST ONE OF THE FOLLOWING
  • Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
  • Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g. hypotonia [collapse], syncope, incontinence)
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  2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours)
  • Involvement of the skin-mucosal tissue (e.g. generalized urticaria, itch-flush, swollen lips-tongue-uvula)
  • Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
  • Reduced blood pressure or associated symptoms (e.g. hypotonia [collapse], syncope, incontinence)
  • Persistent gastrointestinal symptoms (e.g. crampy abdominal pain, vomiting), OR
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  3. Reduced blood pressure after exposure to known allergen for that patient (minutes to several hours)
  • Infants and children: low systolic blood pressure (age-specific) or greater than 30% decrease in systolic blood pressure
  • Adults: systolic blood pressure of less than 90 mmHg or greater than 30% decrease from that person’s baseline

Here’s another case:

A 21-year old female came into the emergency room for dyspnea and development of wheals all over her face and chest minutes after touching their neighbor’s pet cat (exposure to dander). She claimed to have been exposed to cats in the past had never had any allergic reaction to them.

Upon arrival, her O2 saturation was 93% and she was immediately given O2 support, injected with 50mg dyphenhydramine and 100mg hydrocortisone.

After reading the guidelines, I now know that these patients truly had anaphylaxis. This is a better and more accurate-sounding diagnosis than hypersensitivity reaction!