Systemic Allergic Reaction

Patient Presentation:
K.S., a 20 yo female presents to the health clinic for weekly routine allergy injection (trees, grass serum). Peakflow: 370. Lungs clear B/L to auscultation. No SOB. T: 98.4 F. K.S. denies feeling sick today. K.S. states she took antihistamine 2 hrs prior. K.S. denies reaction/issues with prior injection (0.45ml) last week after leaving health clinic. K.S. given 0.5ml (maintence dosage) of allergy serum in left mid-upper arm. K.S. monitored for 30min after injection for any reaction. + 2cm wheal. + Erythema. No edema. No difficulty breathing. K.S. okay to leave health clinic.

One hour post-allergy injection, K.S. returns to health clinic complaining of left arm, facial and lower lip edema, uticaria and erythema. K.S. denies SOB or dyspnea. K.S. denies dysphagia. K.S. denies nausea or vomitting. Upon examination, lungs clear B/L to asculatation. No wheezing, no crackles. Vital signs: HR: 110 bpm, BP: 94/60, T: 98.5 F, POx: 95%., RR: 30.

Diagnosis:
Systemic allergic reaction r/t allergy injection

Treatment:
K.S. given diphenhydramine HCL IM injection 0.5 ml in right deltoid. K.S. given 50 mg of pprednisone PO. Vital signs monitored continually until stable. Respirations and breathing monitored. K.S. denied ambulance/ER visit. Epipen® not administered related to stable vital signs and decreased symptoms post diphenhydramine HCL injection and prednisone administration.

Outcome:
K.S. monitored for 3 hrs until stable. Vitals Signs upon discharge: HR: 80 bpm, BP: 110/72, T: 98.5 F, POx: 99%, RR: 22. K.S.’s vitals are stable. K.S. denies dyspnea. Decrease in edema, erythema and uticaria systemically. K.S. advised to follow-up with allergist and possibly reduce dosage or concentration of allergy injections. K.S. advised to rest and return or call 911 if any difficulty breathing.