Case history
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Choc anaphylactique chez l’enfant et l’adultePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2020Anafylaxie bij kinderen en volwassenenPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2020Case history #1
A 14-year-old girl presents in severe respiratory distress to the emergency department. Her past medical history includes asthma and a peanut and tree nut allergy. Shortly after ingestion of a biscuit in the school cafeteria, she began complaining about flushing, pruritus, and diaphoresis followed by throat tightness, wheezing, and dyspnoea. The school nurse called an ambulance. No medications were administered and the patient did not have an adrenaline (epinephrine) auto-injector prescribed by her allergist. Her physical examination reveals audible wheezing and laryngeal oedema and an oxygen saturation of 92%.
Case history #2
A 65-year-old man reports being stung while working in his garden. He removed the sting and found the dying bee. In the past he tolerated insect stings on several occasions without reaction. On this occasion, within minutes, he experienced flushing, sweating, and a brief loss of consciousness. Too confused to call for help, he was found 10 minutes later by his wife. On arrival of an ambulance he was rousable, without respiratory distress or rash. Systolic blood pressure was 75 mmHg and pulse rate was 55 beats per minute.
Other presentations
A patient may follow a biphasic time course, or the presentation may be atypical and limited to a single organ system (e.g., only laryngeal oedema or gastrointestinal symptoms after shellfish ingestion). Biphasic reactions describe the recurrence of symptoms after resolution of the initial episode and can occur between 4 and 12 hours after the initial reaction. The severity of symptoms is highly variable, with about one third more severe, one third severe, and one third less severe. Anaphylaxis may also occur with no previously known exposure to the allergen, particularly in older adults. The risk of sensitisation to peanut among children exposed to peanut allergens through breastfeeding is the subject of ongoing research.[4][5][6] Simple hypotension after drug administration may represent the beginning of severe anaphylaxis (e.g., radioiodine allergy or secondary to some neuromuscular blockers).
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