23 A 32-year-old woman is brought to the emergen - highsky

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A 32-year-old woman is brought to the emergency department because of difficulty breathing. Soon after eating at a restaurant, she developed chest tightness and flushing of her face and neck, and then the breathing difficulty. Her medical history includes a recent diagnosis of mitral valve prolapse.

In the emergency department, she is anxious and tachypneic, with a respiration rate of 30/min. The blood pressure is 85/45 mm Hg, and the pulse rate is 120/min. She has audible diffuse wheezing and facial flushing. Her condition improves and her vital signs stabilize after treatment with epinephrine, corticosteroids, and H1- and H2-antagonists.

Which of the following is the most appropriate next step in her management?

A Observe for an additional hour and if she remains asymptomatic, discharge her home
] B Hospitalize for further observation
C Discharge her home with a corticosteroid taper over the next week
D Discharge her with instructions for follow-up with an allergist

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BB?

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(Correct Answer = B)


* Symptoms of anaphylaxis include flushing, urticaria, conjunctival pruritus, bronchospasm, nausea, and vomiting which develop within 30 minutes to 1 hour after the offending antigen is injected or up to 2 hours after the antigen is ingested.
* Patients with moderate to severe anaphylaxis should be monitored for at least 12 hours for a possible late recurrence (biphasic anaphylaxis)

The most common causes of anaphylaxis include reactions to foods, drugs, and insect stings. Flushing, urticaria, conjunctival pruritus, bronchospasm, nausea, and vomiting usually develop within 30 minutes to 1 hour if the antigen was injected or up to two hours if ingested. Common food antigens include peanuts, soybeans, eggs, milk, shellfish, and nuts. Anaphylactic shock is caused by severe hypovolemia and vasodilatation. Patients with moderate to severe symptoms should be closely monitored for at least 12 hours, preferably in the intensive care unit for a possible late recurrence (biphasic anaphylaxis), as a result of migration of effector cells into areas of antigen introduction. Observing the patient in the emergency room for another hour would not provide sufficient time to rule out a late-response reaction. Follow-up with an allergist, instruction on use of epinephrine, and a corticosteroid taper are important considerations for patients with anaphylaxis.

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