Question

J.E., a 37-year-old woman with no prior history of allergies, was working in her yard when she received a sting on the right wrist from a yellow-jacked wasp.  Several minutes later she complained of a itching sensation and cramping abdominal pains.  She then became acutely short of breath with wheezing.  A patchy erythema radiating from the area of the sting was noted along with swollen eyelids and lips.  A neighbor took her to the hospital where she became very faint and could not talk or provide information to assist with a diagnosis.  Vital signs were as follows: BP of 60/34; Pulse of 156; Respiration rate of 40

Epinephrine 1/1000 was administered IM along with 100 mg of hydrocortisone.  Within minutes, an improvement in the respiratory rate was noted and blood pressure increased to 100/70 with a pulse of 112.

QUESTIONS:

1. What type of hypersensitivity response is described above?  Go through the process of how this hypersensitivity reaction occurs starting with the initial exposure and then a subsequent exposure; be specific? (3 points)

2. Explain the rationale for each of the following signs and symptoms (3 points total; 0.5 points each)

1. Pruritus
2. Increased pulse
3. Difficulty talking and breathing
4. Feeling faint
5. Erythema
6. Low BP

3) What is the rationale for treating the patient with 100 mg of hydrocortisone and an IM injection of epinephrine? Include in your discussion how each of the treatments alleviates the signs and symptoms (2 points)

Answer 1

2.Sting of the wasp would lead to allergic responses, as the wasp would have injected its venom . Now the venom is the antigen to her body, so her body
produce antibodies .The interaction between an antigen and an antibody results in an allergic reaction. Abnormal response to any stimulus is termed hypersensitivity ,which is a severe form of allergic reaction Severe form of allergy is called anaphylaxis .This is a life threatening condition characterized by hypotension, erythema, tachycardia , bronchospasm, Iayngeal edema, cyanosis , vomiting, diarrhea , seizures even coma & death.

Immunoglobulins of IgE is involved in allergic responses. Two or more IgE molecules bind to the allergen and trigger the mast cells to produce more chemicals like histamine, serotonin, neutrophil factors which are responsible for the signs and symptoms like tachycardia, erythema and hypotension.

Pruritus (itchy skin): The reason behind the occurrence of Pruritus in Mr J is must be the presence of poisonous chemical through the sting These chemicals must have stimulated the release of chemical mediators at the site of sting and this
can causes local Inflammation and itchy skin.

Increased pulse  Tachycardia is abnormal increase in heart rate. This may be a result of hypotension or the allergic reaction may have triggered the histamine response on the heart increasing its rate of contraction and relaxation.

Difficulty talking and breathing: The reason for the occurrence of this is anaphylactic shock, The allergen in the body of JA must have spread to such an extent via blood that it would have cause difficulty in breathing due to pulmonary inflammation The allergen must have also cause vasodilatation leading to blood pressure. All this causes difficulty in talking as well as breathing.

Feeling faint: The allergen ultimately spreads to all the body and begins general actions like causing vasodilatation and hence low blood pressure The less supply of blood to Tie brain makes a person feel gelling fainted

Erythema: As there is tissue injury due to wasp sting, there is diffuse redness noted in skin due to allergic responses .

Low blood pressure: The histamine released by her body during due to the wasp venom has caused the blood vessels to widen which leads to a sudden and severe drop in blood pressure.

3. HVDROCORTISONE : Hydrocortisone is one or the steroid medicine which is used in treating of inflammatory conditions and suppress elevated immune system or persons. it is administers through intravenous route with a dosage ranges from 100 mg to 500 mg it is mainly administered to the patients who are having inflammatory disorders such as Rheumatoid Arthritis, allergic reactions, asthma, etc. This medication is stored at a room temperature of 20-25 c. Hydrocortisone
impairs calcium absorption and formation of new bone, and the patients who are undergoing tor a prolonged treatment ot hydrocortisone develop osteoporosis. Before administering of this corticosteroid it is important to obtain the medical
history or patients like any allergic reactions, drug sensitivity, bronchial asthma, systemic organ deformities, pregnancy stages etc as the drug causes various side effects. This medication reduces the signs and symptoms or inflammation, asthma, allergies.

EPINEPHRINE: Epinephrine is a medication which is used to treat anaphylaxis, bleeding, heart attack. asthma, hypoglycemia, bronchospasm. it is also known as adrenaline or adrenaline. Epinephrine is administered through intravenously,
intramuscular, Subcutaneous routes and in inhalation ions. Epinephrine increases the blood pressure, blood sugar, dilation of pupils in eyes. it is available in the term of auto injector system and the cost of this medication is high Common
concentration of epinephrine is 2.25%. The side effects of this medication includes tachycardia. palpitations, tremor, hypertension, etc.