September 11, 2010

Approach to Anaphylaxis

Case scenario

10 years old malay boy presented to casualty after developing pruritic rash with shortness of breath. Prior to presentation, he is on oral antibiotic for skin infection. Physical examination shows urticaric rash to the arm, trunk and leg. Chest auscultation reveals generalized rhonci and fine crepitation. Recorded vital sign are as follows

BP: 110/ 66 (97 – 122/ 57 – 71)

PR: 136 (60 – 140)

RR: 26 (18 – 30)

T: 37°C

He was treated with IV hydrocortisone 100mg stat, IM Piriton 5 mg stat and salbutamol nebulizer stat. after 20 minutes, the rash are settled. Chest auscultation reveals no more rhonci and crepitation. He was discharged 10 minutes later with tab. Piriton 4 mg t.d.s

On the following night after discharged, he was brought again to the hospital with similar problem.


1) Define anaphylaxis and anaphylactoid
2) What is the pathophysiology behind the condition?
3) What is gold standard for anaphylaxis management?
4) What is the role of steroid in treating the anaphylaxis?
5) Do you think that this patient should be discharged at the first place?
6) Outline your management for the second presentation and what advise would you give to the mother?

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