From the Guidelines
I strongly recommend immediate evaluation and management of the patient's left periorbital edema and redness as it may represent an allergic reaction or a sign of a severe disease, such as rhinosinusitis, requiring prompt intervention. The patient should be assessed for airway compromise, and vital signs should be monitored closely. According to the european position paper on rhinosinusitis and nasal polyps 2020 1, periorbital edema/erythema is a sign of emergency or severe disease.
Key Considerations
- The patient's symptoms may be related to an allergic reaction, which can progress rapidly and involve the airway, or to a severe disease such as rhinosinusitis, which requires prompt referral to a physician 1.
- A thorough medication review should be conducted to identify potential triggers, especially since the patient was admitted for chest pain and may be on new cardiac medications.
- Laboratory evaluation including CBC with differential and tryptase levels may help confirm an allergic etiology.
- The patient should be referred to a physician if they have symptoms that are uncontrolled despite treatment, or if they have signs of severe disease, such as periorbital edema/erythema, severe headache, or signs of sepsis 1.
Management
- Administer diphenhydramine 25-50mg IV/PO, and if symptoms are severe or progressing, epinephrine 0.3-0.5mg IM (1:1000 solution) may be necessary.
- Discontinue any suspected causative medications or allergens.
- Document all findings and interventions in the patient's chart.
- Once stabilized, the patient will need clear documentation of this reaction in their allergy history to prevent future exposures.
From the Research
Allergic Reaction Symptoms
- The patient is presenting with left periorbital edema and redness, which are symptoms of an allergic reaction 2.
- These symptoms can range from mild to severe and may be accompanied by other symptoms such as urticaria, swelling, and abdominal cramping 2.
Treatment Options
- Epinephrine is the first-line treatment for anaphylaxis, a severe and life-threatening form of allergic reaction 2, 3.
- Antihistamines, such as H1 antihistamines, can be used to treat allergic conditions such as allergic rhinitis and urticaria, and may also be used to provide comfort in cases of anaphylaxis 4, 3.
- Corticosteroids may be used in some cases, but their use in anaphylaxis should be revisited due to limited convincing data on their role in management 3.
Management of Allergic Reactions
- Guidelines are available to help determine the severity of allergic reactions and guide treatment and disposition 2.
- The use of epinephrine, antihistamines, and corticosteroids should be based on the severity of the reaction and the patient's individual needs 2, 4, 3.
- Delayed epinephrine administration can be a risk factor for fatal anaphylaxis, highlighting the importance of prompt treatment 3.