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Before you see the patient, you consider the possible causes for these symptoms.
List your differential diagnosis.
- Acute allergic reaction
- Food poisoning
- Anaphylaxis
- Meningitis
- Contact allergy
- Drug reaction/allergy (however, steroids are generally not immunogenic)
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Spend 10 minutes on this next section.
What questions do you ask in your history to differentiate more likely causes?
Hint: Consider feeding history, past medical history, family history.
Your tutors have further information to share to help with the history taking.
- What did they eat?
- Have you had it before/is this the first time it’s happened?
- Do you have any family history of allergies?
- Do you have any family history of atopic conditions, e.g. eczema.
- When did it come on?
- What was he doing when it came on?
- Have you done any exercise prior to the symptoms?
- How are your asthma symptoms, do you have adequate control?
- Are there any other drugs you’re taking, e.g. OTC drugs?
- Do they have any pets?
- Timing: ask before, during and after?
- Are you refusing any food?
- Have you had any abdominal pain?
- Stools: consistency, frequency, colour. Any blood in stool?
- Any swelling?
- Any itchiness?
So do SQITARPS then system-specific questions (see Slide 24 of Immunology Session 2 - Lecture 1)
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What clinic-based investigation would be useful?
Patch/pin prick test and IgE blood
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Patient 1 - Brazil nuts 9 mm (and peanuts 5 mm)
Patient 2 - Viral infection (pt had hives and a fever on onset)
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What treatment advice would you recommend for patient 1?
- Avoid nuts and anything that may contains nuts
- Carry 2 EpiPen and know how to use it and/or someone close to you knows how to use it.
