Answer Happy

A previously healthy 22mth old developed swollen lips following eating some cookies. A month later, he started to vomit, dyspnoea and wheezing, following eating the same cookies, he lost consciousness on the way to A&E. BP 40/0 mmHg (80/60), BPM 185 (80-90), RR 76 (20), breathing was laboured. Anaphylactic shock was diagnosed. He was treated with adrenaline, IV saline, 25mg of benadryl, 25mg mehtylprednisolone. Wheezing dminished, BP 50/30, BPM 145. 30mins later BP dropped 40/20, BPM 170, RR 70. Further treated with adrenaline and aerosolised solution of Albuterol. Repeated 30 mins later. 1 hour later child was responsive, BP70/50, BPM 116, RR 46. The child was admitted and injected with Susphrine. Over the next 24h he was treated further with Benadryl and methylprednisolone. He was taken off meds and discharged.

QUESTIONS: 1) Anaphylaxis results in release of inflammatory mediators, histamine and leukotrienes. Why did the child become hoarse and wheeze? 2) The stimulus for this reaction was most likely peanut allergy. What is the immunological basis of this reaction? 3) When the child attended the allergy clinic he had a skin prick test for nut, milk, egg, corn and wheat allergens. Why? 4) Why was he treated with adrenaline when first presented in A&E? Why was he treated with Susphrine? 5) The incidence of peanut allergy is increasing..... Why? 6) What therapeutic modality might prevent penaut allergy? 7) What is the scientific basis of peanut allergy and pregnancy? a