It’s a sunny day. You are out walking in the park when you see a kid of about 12 years old sitting on a bench. He has a rash on both arms and legs and is leaning over with hands on his knees. What do you do? If you were to open the medical chart of any patient in any hospital in the world today, you would easily find at least one allergy in their record. Whether it is to penicillin, aspirin, latex, or something else, patients often become victims of numerous allergies. While most have mild allergic reactions when encountering their dreaded agents, some are unfortunate enough to develop full-blown anaphylaxis every time they see a banana! But how do we differentiate a mild allergic reaction from the life-threatening condition of anaphylaxis? It all boils down to the clinical presentation. Scenario 1 A 45-year-old male presents with a chief complaint of a rash on his right arm that started developing about two hours ago. Patient states that he was cleaning his basement when he started to have some itching in his right hand. The rash grew in diameter to the present state of about 20 centimeters in length. Patient denies any pain in the area. He has a past medical history hypertension, for which he takes 5 mg of Lisinopril. Patient is allergic to dust. Patient’s last oral intake was four hours ago. Scenario 2 A 25-year-old female was admitted to the hospital two days ago due to a severe infection. Fluids were given intravenously and the attending physician prescribed penicillin. The patient has no pertinent past medical history. The patient is on birth control. The nurse administered the first dose of intravenous penicillin. 15 minutes later, the patient started to develop a rash in the chest and bilateral arm regions, swelling around the mouth, and severe difficulty breathing. The attending physician was called immediately. As you may have already guessed, scenario 2 represents a clear depiction of anaphylaxis (with intravenous penicillin noted as one of the most common precipitating factors of anaphylaxis). The main distinguishing factor from an allergic reaction comes in the form of airway involvement. If a patient feels like their throat is constricting, complaining of difficulty breathing, or presenting with changes in phonation (speaking), these are telltale signs of anaphylaxis. The most commonly practiced treatment for an anaphylaxis reaction, at least in the pre-hospital setting, involves the immediate administration of 1:10,000 concentration 0.3 mg of Epinephrine followed by 50 mg of Benadryl and 125 mg of Solu-Medrol. For an allergic reaction, Epinephrine is placed on standby, in case of development into anaphylaxis, while only 50 mg of Benadryl is administered. Keep in mind that these dosages are for adults. Pediatric measurements are determined based on weight. As you rush over to see the signs presented by that 12-year-old kid in the park, trying to determine the impending occurrence of an anaphylaxis reaction, take a moment to appreciate the subtleties of medicine, those subtleties that can literally make the difference between life and death. Source
