28 year old female presents with complaint of shortness of breath and rash.\u00a0 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.\u00a0 About 30\u00a0 mins later she developed shortness of breath and wheezing.\u00a0 She reports that one hour prior to symptoms devleopment she had eaten Quorn (a mock meat made of mycofungus).\u00a0 In the past she developed a leg rash that occurred after eating Quorn, but it resolved with benadryl.\u00a0<\/p>\n
Upon presentation to hospital:\u00a0 P 98\u00a0 BP 98\/60\u00a0 RR 22\u00a0 Sat 96% RA with diffuse expiratory wheezing, raised red papules on anterior and inner thighs, no oral\/mucosal edema on ENT exam<\/p>\n
The patient’s presentation is consistent with anaphylaxis.\u00a0 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.\u00a0 Monitor for recurrence of symptoms especially in the first 8-10 hours, but symptoms can recur up to 72 hours later.\u00a0 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.<\/p>\n