An eight year-old female was diagnosed with streptococcal pharyngitis by her phy

Question

An eight year-old female was diagnosed with streptococcal pharyngitis by her physician who administered a shot of penicillin in the office. Three minutes after the injection, the child reported feeling a lump in her throat and complained of tightness in her chest. Shortly afterwards, she complained of generalized pruritis (itching).

Physical Examination at that point revealed a very anxious appearing girl in obvious respiratory distress. Her temperature was 100 degrees, pulse 120, respirations were labored at 20, blood pressure was 75 systolic. Her skin showed multiple hives all over her arms and face, varying from 1/2 to 3 centimeters in diameter. Her lungs revealed diffuse wheezing.

Assignment:

1.      The patient responded to epinephrine, diphenhydramine, aminophylline and oxygen, hydrocortisone, and IV fluids.

a.      Explain why IV fluids were administered.

b.      Explain the role of the other medications (yes, you may Google them).

2.      Explain the mechanism of this type of hypersensitivity disorder with respect to the two cell types involved, the antibody involved, and the substances released from the cells.

3.      She was advised to never take penicillin again. Justify this decision.

Explanation / Answer

a) her systolic pressure was down the normal range, to increase her blood pressure, blood volume was raised by IV fluids which would eventually raise the blood pressure

b) epinephrine is a hormone that increases the flight or fight response in the body, in the process it increases blood flow to muscles increasing the tissue oxygenation aiding the respiratory distress of the patient

oxygen is administered to supplement as the anaphylactic shock has put her into respiratory distress

diphenhydramine and aminophylline are anti-histamine which reduce the inflammation due to the allergic reaction.

hydrocortisone possess the properties of glucocorticoids which reduce the immune response and inflammation due to the allergic reaction.

2. This patient has developed a severe anaphylaxis against penicillin. The anaphylaxis is developed due to set of reactions developed due allergic reaction in the body against a particular antigen. This type of allergic response include two types of cells basophills and mast cells. on the surface these cells possess IgE antibodies which bridges together when the allergen binds to these antibodies. When the allergen (1) binds to the IgE on the surface of these cells, they bridge together and a process called degranulation takes place where in the granules inside these cells are released which contain immunomodulatory molecules like histamine, prostaglandin which are involved in manifestation of this hypersensitivity like vasodilation, causing drop in blood pressure, increased contraction of respiratory muscles, causing chest stiffness and respiratory distress, fever etc.

3. If and when she will take penicillin again she will go into another anaphylactic shock and hence she needs to avoid the allergen.

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