Case Study On Drug Induced Anphylaxis

Causes and Symptoms of Anaphylaxis

Anaphylaxis is a potentially life threatening condition of the body that is caused due to allergic reactions. This occurs when a person is exposed to potential allergen like food, certain medicines, mold spores, insect stings, anesthetics, dusts, latex, some chemicals present in cosmetics and more. The different anaphylactic agents may be introduced in the body by ingestion, inhalation or by direct skin contact (Adkinson et ala., 2013). The defense cells of our body can identify these external agents as foreign body and generate certain chemicals that generate immune reaction in the body. This immune reaction may be heightened giving rise to severe anaphylactic reactions, depending upon the type of the allergen (Harper et al., 2010).

Some drugs may be identified as allergen by the immune cells and may give rise to anaphylactic reactions, which can generate life threatening conditions. The intake of drug can occur via any route. Some non steroidal anti-inflammatory drugs can give rise to anaphylaxis (Aun et al., 2014).

This essay aims to focus on the hypersensitivity reaction or the anaphylaxis reactions induced by the broadspectrum antibiotic Flucloxacillin. In the case study Jim palmer who has been brought to the emergency department due to the cellulutis in his lower leg has shown anaphylactic shock reactions after the application of flucloxacillin (Torres & Blanca, 2010) .

A medicine cannot have same effect on every person. Different persons react differently to a particular medicine. The common symptoms that are of lower risks include rashes, swelling of lips and skin, reddening of eyes and skins. Some persons might not develop any adverse reactions at all (Aun et al., 2014). The allergen triggered immune cells like the mast cells release chemicals that sticks to the IgE type antibody and give rise to an immune response. This immune reaction is a type of chain reaction. The immune system of the body helps to defend the body against infections. The immune system reacts with some antibiotics in many ways (Thong & Tan, 2011). The body identifies a particular drug as allergen or a foreign invader and raises immune response which might lead to anaphylactic shock (Adam et al., 2011).  This heightened immune response may give rise to inflammatory reactions causing troubled breathing, swelling and reddening of the skin, development of rashes, wheeziness and many more (Demoly eta ., 2012).

Drug induced anaphylactic reactions are mainly caused due to the IgE type of antibody or the T-helper cells. How anaphylactic reaction is caused by the IgE antibody is well investigated but reaserches are still going on to investigate the role of the T-cells (Lieberman, 2008). Recent researches have thrown light upon the concepts centering the drug reaction. One is the hapten and the prohapten concept and the interactions of the immune receptors present in the immune cells by the antibiotics (Adam, Pichler & Yerly, 2011).

In T cell mediated allergic drug reaction, the antibiotics can stimulate the T-cell receptor which can lead to the formation of a cross-reactive major histocompatibility polypeptide compound. Therefore, it is not that previous interaction with the drug is obligatory (Dona et al., 2011). Hapten carrier complexes can be antigenic to both B and T cells. The B cells that are drug specific can proliferate into plasma cells, which can give rise to hypersensitive reactions. For this reason the hypersensitive characteristics of the developed drug should be assessed for its hapten like characteristics and its ability to give rise to an anaphylactic reaction (Mcneil et al., 2015). Furthermore the cross reactive antigens which are drug independent can also cause sensitization which may lead to drug allergy.

Hypersensitivity reaction induced by Flucloxacillin

The given case study focuses on the drug induced anaphylactic reactions. It is evident from the case study that the patient had been suffering from cellulitis (Stern, 2012). As he was brought to the emergency department of the hospital, he was administered flucloxacillin, which is an antibiotic that is normally given in patients having fungal and bacterial infections.

Symptoms of Anaphylactic reactions includes – Rashes, dizziness, vomiting, rapid or weakened pulse , shortness of breath which can worsen with time, tightening of the chest and throat. All these symptoms can be related to the manifestations showed by Jim Palmer (Liew, Williamson & Tang, 2010).

The case study depicts that the person was suffering from cellulitis. It is to be noted that it is a bacterial disease that normally occurs in legs, which can cause redness and swelling. In case of cellulites flucloxacillin is normally used (Khan & Solensky, 2010).  

In case of drug induced anaphylaxis, a person’s airways may narrow which can lead to respiratory distress and troubled breathing. In the case study it can be clearly seen that the blood pressure of the person had fallen drastically, which can be caused due to the fact that the anaphylactic reactions might have caused the leakage of the blood in the tissue or the blood vessels might have dilated (Bayer et al., 2012). When the major organs of the body do not get efficient amount of blood, the body goes into an anaphylactic shock.

Laboratory procedures for the diagnosis of anaphylactic reactions are always not reliable. A patient should show an elevated level of plasma histamine, within 1 hour of the onset of the symptoms. Level of plasma tryptase levels greater than 15ng/ml is the confirmatory test of the anaphylactic shock. It should be noted that it produce false negative results in case of the food induced anaphylaxis (Rueff et al., 2011).  Single measurement is not as reliable as tryptase measurement. Mast cell tryptase is usually used in the laboratory as the confirmatory test for the anaphylactic reactions. Elevated level of IgE in the blood and the skin test are always not reliable for determining the anaphylactic reaction (Sadlier et al., 2013).

In order to start with the treatment of anaphylactic reactions, it is important to remove triggering factor of the reactions, but it is always not possible to do so, like in this case as it is a drug induced anaphylactic reactions. Initial treatment of the anaphylactic shock is the application of the epinephrine (Muraro et al., 2014). In case of severe reactions epinephrine can be administered. But it should be kept in mind that epinephrine has got several side effects, therefore dosed has to be considered. If severe shock occurs, the muscles and the skin might show impaired perfusion, in that case an intramuscular and the subcutaneous doses will not be properly absorbed in the circulation. Type IV epinephrine can be administered in such cases (Pitcher et al., 2010). Too fast application of epinephrine can cause adverse effects like dyrrhythmias or severe palpitations.

Treatment of Anaphylactic Reactions

Name of the patient: Jim Palmer. He is a farmer who is 53 years old. He has been admitted in the morning with severe cellulitis in his leg.

Jim Palmer had been admitted to the emergency department with severe cellulitis in his leg. As per the treatment regimen, he had been given one dose of FLucloxacilline 1gram IV as a slow bolus. Within 10 minutes from the application of the second dose of flucloxacillin, he had developed severe hypersensitive reactions. He was suffering from acute respiratory trouble, feeling tightness in the throat, light headedness and dizziness. He had also developed urticarial rashes and swollen lips. It has been identified that Jim’s chest movement is bilateral and a low wheeze can be heard along with a central cyanosis. Jim is only responding to voices and has become drowsy. His conditions are deteriorating and his level of unconsciousness is gradually increasing.

No such past history of allergic reaction has been noted.  Jim was not under any medication.

The vital signs of Jim included Respiratory rate- 26bpm, Blood pressure- 99mm Hg systolic pressure, SaO₂ 91% on RA, body temperature-37.4?, the peripherals are cool and clammy. The capillary refill time is greater than 4 seconds. The blood glucose level is 5.3 mmols/ltr. Urticarial rashes have developed in his lips, fingers and toes.

Two doses of Flucloxacillin 1 gram IV has been administered prior to the development of the anaphylactic reactions.

The patient is in the ‘red zone’ and therefore requires immediate attention. His responses and his visibilities are gradually showing deterioration. Initial doses of Epinephrine can be administered to start with the treatment (Romano et al., 2011). Since the patient had already shown reactions against a drug, care should be taken during the administration of the epinephrine (Kowalsky eta l., 2013). It is recommended to conduct the serum tryptase test as a confirmatory test.

As perceived from the given case study, anaphylaxis reactions can lead to life threatening condition if not treated timely and properly. Therefore few things have to be kept in mind regarding the administration of any antibiotics. The professionals and the nurses should be a careful while administering Beta lactams, anti-inflammatory drugs, latex and many more. Simple strategies can be made to prevent any adverse reactions, like identification of the route of administration. Identification of the past medical history of a patient is necessary as cross reactivity of the drugs may generate hypersensitive reactions. In a nutshell the key factors for the management of the anaphylactic reaction are early assessment, diagnosis and quick interventions.

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