Usually within hours to 1 week. HOWEVER, angioedema may still occur suddenly even though the drug has been well tolerated for years.
Source
Habif: Clinical Dermatology, 5th ed.
Source
Habif: Clinical Dermatology, 5th ed.
Showing posts with label Allergic/Immu'logic. Show all posts
Showing posts with label Allergic/Immu'logic. Show all posts
What is the ideal route for epinephrine administration for the initial treatment of anaphylaxis?
IM in anterolateral thigh q 5 - 15 minutes x 3.
Absorption is more rapid and complete in this location relative to SC; IM in deltoid.
Because of the risk for potentially lethal arrhythmias, epinephrine IV should be avoided unless the patient is in cardiac arrest or profoundly hypotensive despite multiple epinephrine IM injections and IV fluids.
Source
Oswalt, M. and Kemp, S. "Anaphylaxis: Office Managment and Prevention" Immunology and Allergy Clinics of North America. May 2007.
Absorption is more rapid and complete in this location relative to SC; IM in deltoid.
Because of the risk for potentially lethal arrhythmias, epinephrine IV should be avoided unless the patient is in cardiac arrest or profoundly hypotensive despite multiple epinephrine IM injections and IV fluids.
Source
Oswalt, M. and Kemp, S. "Anaphylaxis: Office Managment and Prevention" Immunology and Allergy Clinics of North America. May 2007.
Really? You're allergic to normal saline???
Is this possible?
Perhaps. A quick review of the literature reveals two to three case reports of normal saline allergy. One was published recently in the American Journal of Emergency Medicine this year which reports on a woman who became tachycardic and developed a erythematous rash after administration of sterile NS.
I'm a bit incredulous but I guess anything is possible. Despite Darwinian forces which generally eliminate people with significant allergies to the basic elements of life, perhaps some still sneak through. Anyone ever hear of an oxygen allergy?
Source
Ay, D. et al. "An unusual cause of allergy: case report of normal saline allergy" American Journal of Emergency Medicine. v 27. 2009.
Perhaps. A quick review of the literature reveals two to three case reports of normal saline allergy. One was published recently in the American Journal of Emergency Medicine this year which reports on a woman who became tachycardic and developed a erythematous rash after administration of sterile NS.
I'm a bit incredulous but I guess anything is possible. Despite Darwinian forces which generally eliminate people with significant allergies to the basic elements of life, perhaps some still sneak through. Anyone ever hear of an oxygen allergy?
Source
Ay, D. et al. "An unusual cause of allergy: case report of normal saline allergy" American Journal of Emergency Medicine. v 27. 2009.
Name 7 antimicrobials that should be avoided in patients with an allergy to sulfa antimicrobials. (Hint: all drug names include "sulfa" prefix)
1. Sulfamethoxazole (Bactrim)
2. Sulfamerazine
3. Sulfamethizole
4. Sulfamoxole
5. Sulfamethazine
6. Sulfoxazole
7. Sulfapyridine
Numbers 2 - 7 .... huh? Never heard of them. Looked 'em up and they don't seem to have a wide clinical utility and especially not in the emergency department. For my purposes in the ED, antimicrobial sulfa allergy = NO BACTRIM. There are sulfonamide NON-antimicrobials (including Furosemide, Bumetanide, Hydrochlorothiazide, Acetazolamide, Diazoxide, Sumatriptan, Alyburide, Celecoxib, Sulfasalazine) but the potential for cross reactivity between these drugs and sulfa antimicrobials is close to nil.
Source
Montanar, A. "Allergies to sulfonamide antibiotics and related drugs" Up to Date. 11 Feb 2009.
2. Sulfamerazine
3. Sulfamethizole
4. Sulfamoxole
5. Sulfamethazine
6. Sulfoxazole
7. Sulfapyridine
Numbers 2 - 7 .... huh? Never heard of them. Looked 'em up and they don't seem to have a wide clinical utility and especially not in the emergency department. For my purposes in the ED, antimicrobial sulfa allergy = NO BACTRIM. There are sulfonamide NON-antimicrobials (including Furosemide, Bumetanide, Hydrochlorothiazide, Acetazolamide, Diazoxide, Sumatriptan, Alyburide, Celecoxib, Sulfasalazine) but the potential for cross reactivity between these drugs and sulfa antimicrobials is close to nil.
Source
Montanar, A. "Allergies to sulfonamide antibiotics and related drugs" Up to Date. 11 Feb 2009.
What is the cause of Henoch-Schonlein purpura?
Unknown.
While a variety of infectious and chemical triggers have been proposed, the underlying cause is unknown.
Sorry for the not-so-satisfying "answer".
Source
Dedeoglu, F., Kim, S., Sundel, R. "Clinical manifestations and diagnosis of Henoch-Schonlein purpura" Up to Date. Jan 2009.
While a variety of infectious and chemical triggers have been proposed, the underlying cause is unknown.
Sorry for the not-so-satisfying "answer".
Source
Dedeoglu, F., Kim, S., Sundel, R. "Clinical manifestations and diagnosis of Henoch-Schonlein purpura" Up to Date. Jan 2009.
Other than primary skin disorders, what are some causes of pruritus (itching)?
Lots of primary skin disorders ie xerosis, atopic dermatitis, contact dermatitis, urticaria, dermatophytosis, psoriasis, scabies and pediculosis cause itching.
However, if there are no skin lesions and a patient is complaining of pruritus other disorders to consider include:
Fazio, Sara MD. "Pruritus." Up to Date. 2 Oct 2008.
However, if there are no skin lesions and a patient is complaining of pruritus other disorders to consider include:
- renal disease
- cholestasis
- malignancy - most commonly Hodgkin lymphoma, Polycythemia vera, Mycosis fungoides (cutaneous T cell lymphoma)
- multiple sclerosis
- thyroid disorders
- psychiatric illness
Fazio, Sara MD. "Pruritus." Up to Date. 2 Oct 2008.
How is Henoch-Schonlein Purpura (HSP) diagnosed?
Clinically via the presence of the following tetrad:
In patients with an incomplete or unusual presentation, biopsy of the affected organ (ie skin, kidney) demonstrating predominantly IgA deposition supports the diagnosis.
Source
Dedeoglu, F. MD et al. "Clinical manifestations and diagnosis of HSP." Up to Date. May 2008. <http://www.uptodate.com>
- palpable purpura without thrombocytopenia and coagulopathy
- arthralgia
- abdominal pain
- renal disease
In patients with an incomplete or unusual presentation, biopsy of the affected organ (ie skin, kidney) demonstrating predominantly IgA deposition supports the diagnosis.
Source
Dedeoglu, F. MD et al. "Clinical manifestations and diagnosis of HSP." Up to Date. May 2008. <http://www.uptodate.com>
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