28 year old female with Quorn Allergy
28 year old female presents with complaint of shortness of breath and rash. She reports that one hour prior to presentation she developed a rash on her inner thighs, so she took benadryl with no relief of symptoms. About 30 mins later she developed shortness of breath and wheezing. She reports that one hour prior to symptoms devleopment she had eaten Quorn (a mock meat made of mycofungus). In the past she developed a leg rash that occurred after eating Quorn, but it resolved with benadryl.
Upon presentation to hospital: P 98 BP 98/60 RR 22 Sat 96% RA with diffuse expiratory wheezing, raised red papules on anterior and inner thighs, no oral/mucosal edema on ENT exam
The patient’s presentation is consistent with anaphylaxis. Key management for anaphylaxis includes: epinephrine (0.3-0.5mg IM, 1mg/mL), oxygen, fluids, H1 antihistamine (benadryl 50mg IV), H2 blocker (ranitidine 50mg IV), steroids (125mg methylprednisolone IV), and bronchodilators. Monitor for recurrence of symptoms especially in the first 8-10 hours, but symptoms can recur up to 72 hours later. Patient’s should be admitted and observed at least 12 hours and discharged home with instructions to avoid the potential allergen and with a prescription for EpiPen 0.3mg to use at that onset of symptoms in the future.