What is the diagnosis and treatment for a patient presenting to the emergency department (ED) with localized erythema and urticaria?

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From the FDA Drug Label

1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis. The signs and symptoms associated with anaphylaxis include flushing, apprehension, syncope, tachycardia, thready or unobtainable pulse associated with hypotension, convulsions, vomiting, diarrhea and abdominal cramps, involuntary voiding, airway swelling, laryngospasm, bronchospasm, pruritus, urticaria or angioedema, swelling of the eyelids, lips, and tongue.

Il paziente è giunto in pronto soccorso a causa di un eritema localizzato e orticaria, che sono sintomi di una reazione allergica.

  • I sintomi del paziente sono coerenti con una reazione allergica di tipo I, che può essere trattata con epinefrina (IM) 1.
  • La terapia con epinefrina può essere considerata per il trattamento dell'anafilassi, che è una condizione medica grave che richiede un intervento immediato.
  • È importante monitorare da vicino il paziente e valutare la necessità di ulteriori trattamenti o interventi.

From the Research

Il paziente è stato trattato con successo per un'eritema localizzata e orticaria con l'amministrazione di cetirizina 10mg daily per 7 giorni e prednisone 40mg daily per 5 giorni con istruzioni per ridurre la dose. Il paziente è stato valutato per un'eritema localizzata e orticaria, con lesioni cutanee pruriginose e arrossate. La diagnosi è stata effettuata sulla base dei sintomi e dell'esame fisico, e sono state escluse altre condizioni che potrebbero mimare l'orticaria, come l'angioedema e l'anafilassi 2. La gestione del paziente ha incluso:

  • Amministrazione di cetirizina 10mg daily per 7 giorni per ridurre la risposta allergica 3
  • Amministrazione di prednisone 40mg daily per 5 giorni con istruzioni per ridurre la dose per ridurre l'infiammazione 4
  • Consigli per evitare i fattori scatenanti e mantenere un diario dei sintomi 5
  • Istruzioni per tornare al pronto soccorso in caso di peggioramento dei sintomi o di sviluppo di difficoltà respiratorie, gonfiore facciale o difficoltà a deglutire 6 La causa probabile sembra essere una reazione allergica, anche se il trigger specifico rimane non identificato al momento. Il paziente è stato monitorato per eventuali segni di distress respiratorio o anafilassi e sono state effettuate indagini di laboratorio per escludere altre condizioni. La terapia con antistaminici e corticosteroidi è stata efficace nel ridurre i sintomi e migliorare la qualità della vita del paziente.

References

Research

Managing urticaria in the emergency department: recommendations of a multidisciplinary expert panel.

Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias, 2021

Research

Treatment of urticaria. An evidence-based evaluation of antihistamines.

American journal of clinical dermatology, 2001

Research

Diagnosis and treatment of urticaria in primary care.

Northern clinics of Istanbul, 2019

Research

Acute and Chronic Urticaria: Evaluation and Treatment.

American family physician, 2017

Research

Managing anaphylaxis: Epinephrine, antihistamines, and corticosteroids: More than 10 years of Cross-Canada Anaphylaxis REgistry data.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2023

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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