Supporting Primary Healthcare Professionals

Quick Assessment C – Lucia

Lucia is a 10 year old girl who presents with sudden onset swelling of lips, eyelids and abdominal pain. She had vomited on the way to the urgent care centre.

• In the past, she had had a hive-like rash with whole eggs. She can now eat eggs without problems.
• This reaction happened after she had an egg pasta with pesto sauce (containing cashew).
• OE: Lucia had swelling, as above. There was no rash, but she had watery, red eyes.
•  Initial observations are:  Saturations 97% in room air; pulse rate 135 per minute; respiratory rate 35 per minute.

Welcome to your Quick Assessment C: Lucia

Is this anaphylaxis?

Yes

No

What treatment would you give first?

Adrenaline autoinjector 300 mcg

Adrenaline autoinjector 150 mcg

PO chlorphenamine 4 mg

PO prednisolone 30 mg

PO cetirizine 5mg

PO cetirizine 10 mg

Two hours later

Lucia was more breathless and had dry cough. Swelling had resolved, but she had bilateral wheeze on auscultation. Observations are: Saturations 94% in room air; pulse rate 130 per minute; respiratory rate 35 per minute.

Is this anaphylaxis?

Yes

No

What single treatment would you give first?

Adrenaline autoinjector 300 mcg

Adrenaline autoinjector 150 mcg

PO chlorphenamine 4 mg

PO prednisolone 30 mg

PO cetirizine 5mg

PO cetirizine 10 mg

Nebulised salbutamol 5 mg

What investigations will you collect?

None

Serum tryptase

Specific IgE to egg

Specific IgE to nut mix

Specific IgE to egg and nut mix

Other

Lucia was admitted overnight and fully recovered. What medication does she need at the point of discharge?

None

Oral chlorphenamine, if needed

Oral cetirizine, if needed

Oral chlorphenamine and x2 adrenaline autoinjectors, if needed

Oral cetirizine and x2 adrenaline autoinjectors, if needed

Does Lucia need to be referred to an allergy clinic?

Yes

No

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