John Baker Case Summary

Case History
John Baker a nine-year-old male, was admitted to the emergency room with the chief complaints of wheezing during respiration, swelling and erythema of the right arm distal (below/farthest away from) to the humerus, and slight vertigo (dizzy/ room spinning). The patient is responsive; however, he seems confused. The patient was playing outside, when a wasp stung him on the anterior region (front/top region) of the forearm. The patient’s mother watched the incident unfold, and promptly removed the stinger from the sight of injury with tweezers. The patient has no history of allergies or major medical ailments. The patient’s father has a known history of being allergic to wasps, and there are no other know family members with allergies
He then experienced difficult breathing accompanied by swelling and redness to the region of trauma. With the patient’s symptoms and his paternal history of allergies to wasps, treatment of anaphylaxis should be done before any tests are done. First epinephrine is administered to stop the allergic reaction, and oxygen is administered to raise the patient’s blood oxygen levels. Injections of antihistamines and cortisone are also given to the patient to help reduce the swelling of the trachea reliving some of the difficulty related to breathing. After the patient’s vitals and respiration returns to normal and the patient is stable a Tryptase blood test is done to verify elevated mast cell activation, and rule out Mastocytosis (disorder in which mast cells are activated in large numbers). A histamine blood test is also done to verify anaphylaxis and rule out Mastocytosis. An Immunoglobulin E (IgE) blood test is done to see if the immunoglobulin levels are elevated, and a complete blood count (CBC) is done to see if there are elevated levels of eosinophil white blood cell are elevated (2). Heart and lung disorders can be ruled out using an ECG and chest x-rays (1). The Tryptase blood test show elevated tryptase levels. The histamine blood test shows elevated levels of histamine. The CBC shows elevated eosinophil white blood cell levels. The IgE test indicates elevated levels of immunoglobulin. The ECG shows NSR,
Treatment Immediate administration of epinephrine, oxygen, antihistamines, cortisone, and a beta-agonist to get the allergic reaction under control (1). The patient is a candidate for immunotherapy (multiple allergy shots) to reduce the severity of any allergic reaction in the future (1). The patient should avoid the allergy trigger if possible, and keep a diary of reactions to rule out any other contributing allergy triggers other that the wasp sting (1). Prescribe an epinephrine pen for fast immediate response to an allergy trigger, and seek emergency medical assistance directly after administration of epinephrine (1). Wear a medical ID tag indicating an allergy to wasp stings.
Follow Up
An appointment is scheduled with an allergist to rule out any other possible triggers of the anaphylaxis, and verify that the reaction was in fact anaphylaxis. This will allow the patient to know exactly what he is allergic to, and what he should avoid in the future. Reinforcing the importance of quick utilization of the epinephrine pen, and seeking medical assistance if contact with the allergy trigger happens in the