Patient presents to the emergency room with edema of tongue, stridor, dyspnea, hoarseness and itching following peanut consumption. Most likely cause is:
Ref: Harrison's Principles of Internal Medicine. 18th edition, Page 2711 Explanation: Patient presents with acute onset stridor, dyspnea, tongue edema and hoarseness following peanut consumption. The most likely diagnosis here is Angioneurotic edema. ANGIONEUROTIC EDEMA (AKA QUINCKE'S EDEMA) It is a life-threatening allergic condition. Rapid edema of the deep layers of skin. Characteristic Presentation o Intense bronchospasm. o Vascular collapse o Shock without antecedent events. Symptoms occur within seconds to minutes of exposure to the agent. Laryngeal edema o Lump in throat o Stridor. Bronchial obstruction o Chest tightness o Audible wheeze. Cutaneous manifestations include: o Urticaria. o Pruritis o Flushing o Feeling of warmth. GI manifestations include: o Nausea. o Vomiting. o Crampy abdominal pain, o Diarrhea. Know n Triggers o Agents responsible include some hormones, enzymes, pollen, dust mites, animal dander. o Food: Peanuts, milk, egg, seafood, nuts, grains, beans. o Rubber latex, ethylene dioxide, o Hymenoptera venom, o Dextran. o Thiomersal. o Antibiotics--penicillin, cephalosporins, amphotericin-B, o Anaesthetics--Lidocaine, Procaine. Treatment: o Adrenaline 0.3-0.5 mL of 1:1000 SC/IM o IV Diphenhydramine 50-100 mg IM o Nebulised Salbutamol o IV Glucocorticoids. Angioedema: Localised edema of involving subcutaneous tissue. Urticaria: Involves superficial portion of the dermis. Angioedema is elicited by ingestion of fresh fruits, shellfish, fish, milk products, chocolate, legumes including peanuts and various drugs. Classified as: o IgE dependent o Bradykinin-mediated o Complement-mediated o Non-immunological o Idiopathic. Hereditary angioedema: o Autosomal dominant o Due to Cl INH deficiency.
Foreign body larynx
Foreign body bronchus
Angioneurotic edema
Parapharyngeal abscess
Diseases of Immediate-Type Hypersensitivity