General Medicine
Diseases of Immunity & Hypersensitivity
Clinical Case Study
Dr. J. Satish Kumar, MD, Department of Basic & Medical Sciences,Faculty of Dentistry, Ajman University of Science & technology
Practical Series
Case Study 1
• A 27-year-old man is referred to the allergy clinic for symptoms of hives* for 2 months.
• The lesions are pruritic and not painful. They heal without residual bruising or hyperpigmentation. Possible triggers have not been identified.
• He has had several episodes of lip swelling but no throat or laryngeal involvement.
NB*Hives are described as a raised and itchy skin rash that occurs on the entire body with each individual hive lasting less than 24 hours.
Patient Details Past Medical History
Negative.
Allergies
No known medication allergy.
Family Medical History
Hay fever - mother.
Physical examinationExternal ears normal. Canals clear. TM's normal. Nasal mucosa normal. No drainage or sinus tenderness. Lips, tongue normal. Oropharynx clear.Neck: supple, no adenopathy.CVS: RRR, normal S1/S2
Skin: Hives +
Physical Examination
QQ-1
• What is your provisional diagnosis ?
Q-2
• What advice would you suggest?
AProvisional Diagnosis
• Chronic urticaria.
Advice• Screening lab work.• Anti Histamines for
symptomatic relief
Allergy Skin Prick Test: Final Diagnosis
• Allergic tests reveal no specific allergen
• Chronic Idiopathic Urticaria
Case Study 2
• A 45-year-old arrives to the ED in semi-conscious state.
• During examination his voice became hoarse, oxygen saturation decreases.
• He was working on his house when he was attacked by bees.
Patient Details Physical examination
Drowsy but following commands.VS: BP 100/50, HR 101, RR 18, SpO2 93% on RA.HEENT: bilateral swollen upper eyelids, no tongue swelling, posterior oral pharynx visualized.Chest: no respiratory distress, no crackles or wheezing.CVS: no murmurs, rubs or gallops, regular rate and rhythm.Abdomen: Soft, NT, + BS.
Skin: generalized rash.
Physical Examination
QQ-1
• What is your most likely diagnosis ?
Q-2
• How will you manage this case?
ADiagnosis
Anaphylactic shock due to allergic reaction to bee sting.
Management Drugs used for management of
anaphylaxis are remembered by the mnemonic EASI:
Epinephrine IMAntihistamines PO, IMSteroids PO, IM, IVInhaled b2-agonists, if wheezing;
IV fluids, if hypotensive
Management of anaphylactic shock case
• The anesthesiology team should be called along with ENT
• To look for glottic swelling.• MICU team should be alerted and the patient
admitted for mechanical ventilation if necessary and further treatment.
• Follow-up appointment with an allergist.
Mind Map
* FIDLFoods, 36%Insect stings - bee and wasp, 15%Drugs, 17%Latex rubber
Case Study 3• A 22-year-old married female is referred to the clinic with rashes in hands
after she was taking care of her ailing grandmother when she had to use gloves often.
• She also reports that she used an eyelash extender 5 months ago and she had eyelid swelling after she removed the eyelashes.
• A month ago, she was at the hairdresser who was applying hair extenders to her scalp . Within six minutes of applying the extenders, she started to complain of feeling a lump in her throat; she started to have shortness of breath, and hives which affected her face, arms, legs, and back.
• She was sent to the ER where she was given an injection of corticosteroid. • Her symptoms resolved within an hour. She has not used the same hair
extenders or the eyelash application.
Patient Details
Past medical history (PMH)
Negative.
Medications
None.
Social history
Nonsmoker. No pets. Nursing student.
Family history
No history of allergic disease or reaction to latex.
Physical examination
Vital signs stable. Normal nose and throat exam. Respiratory system: Clear to auscultation bilaterally. Cardiovascular system: Clear S1, S2. Abdomen: Soft, non-tender, non-distended. Extremities: no edema. Skin: no rashes.
Physical Examination
QQ-1
• What is your provisional diagnosis ?
Q-2
• What precautions would you suggest?
AProvisional Diagnosis• Latex allergy
Advice• This is a patient with latex allergy and
she should be advised to avoid all latex products including gloves, latex-based glue, hair extenders, condoms, etc.
• She was advised to discuss workplace avoidance measures and also to avoid foods, which may cross react with latex.
• A comprehensive list of latex-containing products and cross-reactive foods should be provided to the patient.
• The patient should take a skin prick allergy test.
Final diagnosis
Latex allergy
Summary
Latex is most often referred to the cytoplasmic exudate of the Hevea brasiliensis tree, hence the name Hev b allergens. There are more than 250 latex proteins but only 13 proteins have been characterized and designated as Hev b allergens. Skin prick reactivity to Hev b 5, 6, 7 identifies 93% of workers allergic to latex.
Mind Map
