Pseudoallergic Angioedema Emergency
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- เผยแพร่เมื่อ 3 ต.ค. 2024
- This toddler presented with angioedema of the face and hands as well as urticaria of the extremities. We suspect her presentation was a type 3 psuedoallergic reaction to the ibuprofen she was taking. We present information on this condition.
Thank you, Dr. Mellick and the patient's mother! This lesson is valuable for us pharmacy students
Great to hear!
Hope this precious one is doing well. Love how aware she is of her personal boundaries & able to communicate them so effectively as a toddler. I also appreciate how considerate/attentive you were to respecting her boundaries while treating her. Great informative video of ideal bedside manor Dr.!!
Interesting case. Thanks to the Mom for sharing it for education purposes.
Agreed!
THANK YOU BOTH -Nursing Student
Wow I know so many wonderful USA Health doctors, it just makes me want to be a doctor even more!!! These videos make me so excited.
Cool!
Dr. Mellick you are a god sent!
specially these days to us who are in the first few years of medical school and we're not allowed to be in the hospital because of the pandemic, it's really useful and educational, Thank you for the work you're doing as a doctor and as an educator .
Thank you. I really appreciate the feedback!
I had an allergic reaction to Lisinoprol, an Ace Inhibitor that I had taken for about 7 years. I was in the hospital for something minor and given my morning dose of my blood pressure medicine. Within 30 minutes my neck swelled and a code was called. I woke up 2 days later in the ICU on a ventilator. I was on it for 21 days and then went to step down for 3 more weeks with a tracheotomy. I developed double pneumonia and MRSA while in the ICU. It was quite an experience.
This is an amazing channel. Crazy to find so much good content. Look through the old vids if you haven't already. From pneumothorax Tx, to IO lines - really great stuff.
Thanks Dr. Mellick!
My pleasure! You are welcome!
These videos are informative👍
Excellent! Glad to hear they are helpful.
Great and informative video. Thank you.
Glad it was helpful!
Thanks for all the great content!
You are welcome!
why was the edema asymmetric? I would have expected these to be bilateral
Don't know, but it is not uncommon for angioedema from various conditions like ACE inhibitors (bradykinin related) to be asymmetric. We see that a lot.
@@lmellick Thank you!
nice video doctor, excellent information for health workers.
Thank you!
Thanks. You're a rockstar, Dr. Mellick.
I have tested highly, highly allergic to NSAIDs. Fortunately it is a relatively easy allergen to avoid as long as you educate yourself on over the counter medications.
That is good advice.
Another great informative video ...thanks.
Thank you!
Thank you for another good learning video
Our pleasure!
thank you ❤️
How has someone already disliked this video?
Information on PowerPoint slides sometimes isn't seen as interesting.
@@lmellick Ignore the haters. Your work is fantastic. Thank you.
@@maltlickytexas Thank you!!
This is happening to us too. Let hurting then face swollen with right eye close. Restless leg as well. Trying to figure out what it could be
My lip and face has been swelling like that, I wake up like that, but my allergy medicine Allertec and Famotidine has no effect, took me off any nsaids. The allergist has done an inhalant panel and I’m allergic to dust mites, which I knew because I get typical symptoms while cleaning. Does anything else cause this besides nsaids?
Isn’t that an emergency? Why wait and not give epe right away?
Angioedema (as we know with ACE inhibitors) can affect the airway, but there was no evidence of such. This was not an anaphylaxis event in which we give epinephrine immediately intramuscularly, however, it deserved a trial and appeared to help.
@@lmellick oh but wasnt angioedema shown in this video? Maybe you can make a video to help clarify for me.
BC airway is still maintained and pt is in emergency service
Thanks sir
You are welcome!!
Hi there. Thank you for make so great videos. I just have one question... Why prescribe Famotidine if it is an H2 receptor antagonist?
There is some evidence and thought that H2 receptor antagonists also block histamine release. Additionally, I also often use first and second generation H1 blockers together.
Did she have genu varum? Maybe vitamin d deficiency could explain the pain and the bowing of the leg(it seemed to me like that in the video)
It didn't appear to be the case.
@@lmellick Oh ok gave it a shot😂 anyway love your videos, thankyou 😀.
@@prathiky8830 No problem!! Thanks for the comments.
Yep, watching my swelling fade day after day until it completely vanished was such a relief, I went with what I pointed out and within the first 10 days or so the angioedema was barely visible! I just go'ogled the latest by Shane Zormander and after 20 days my skin has never been healthier!
Is pseudoallergy dangerous? Please tell me
Yes, it can be potentially fatal in the worst cases.
@@lmellick I don't why I have suddenly developed hypersensitivity to all foods. I can't tell you how upset I am. Whatever I eat my body becomes sensitive to it and next when I eat I lt causes allergy. I'm literally starving right now. First it was with medicine. Now all foods are becoming sensatized.. What should I do
@@sheezasyed8746 Definitely start with by seeing an allergist. The Lone Star Tick bite can cause allergy to meats. th-cam.com/video/0jF0k5ZuQoo/w-d-xo.html
Was the H1 and H2 administered PO? Also, was the Epi concentration 1:1,000?
Yes, to all your questions. Thank you.
I have so many weird allergies. Motrin ASA dilaudid latex iodine
I go from full anaphylactic to my tongue swelling and the back of my throat closing or my tongue swelling. Is this similar?
Pseudoallergic reaction are mainly due to inhibition of cox 1 and subseqent release of ltc4,e4,d4 and inhibition of antiinflammatory pge2.
A question, is it really called type 3 pseudoallergic reaction.
Sry ibuprofen is a non selective cox, i misphrased.
is there any way to tell whether it's true IgE mediated or a pseudo allergic reaction or would you always just give Epi and treat it as anaphylaxis regardless? Did you discharge them with an epipen?? Thank you for your awesome videos!
I've spent a lot of time trying to understand if that is possible and reviewed scores of PubMed articles and I just could not find those specifics anywhere. Even the types described seem to be based on clinical patterns (chronic urticaria, no chronic urticaria, itching, etc.) If someone more knowledgeable sees this and wants to comment, it would be appreciated. However, I understand it as psuedoallergic can be a histamine release from Mast cells without the IgE being involved. If that is the case, than I would do standard treatments. Since this was not an anaphylaxis pattern, we did not send an EpiPen home with the patient. Stopping the ibuprofen was all she needed and she did improve with that I learned in a follow-up call. Again, I really don't have a good handle on the molecular level of this and I'm suspicious based on my research that I am not alone. Again, any help would be appreciated.
I think the only way to make sure of that is to mesure the IGe specific antibodies.
in anaphylactic shock they are present since it's type 1 hypersensitivity .
Anyways you can't get anaphylactic shock from NSAIDs you get it from betalacatmines medications
@@lmellick.
I had braces n had it on for 2 weeks with tongue n lip swelling ...got braces removed yet still swelling of tongue continued on and off .i was told was angioedema put on (2weeks after removal)prednisone 30mg for 5 days and month of cetirizine one daily . almost 2 weeks of meds n im still getting tongue swelling almost daily tho improving bit. drs said it may take while for metal to leave system .idk 😓🤷♀️.losing hope .why its taking this long to clear up.(I have 2 metal porcelain crowns few yrs old dont know if its playing part to)
Get a second opinion? Something doesn't seem right.
I've gotten 3 n each seem to agree with other 😓.they are running cbc, esr and total IGE if meds don't work after month .
Any updates please?
Dr. Mellick, I am presuming that the epi administered was 0.15mg? With the amount of edema and urticaria present, would be this be referred to as a systemic or a central reaction? Can you explain COX-1 and COX-2 NSAIDs?
The main mechanism of action of NSAIDs is inhibiting an enzyme called cycle-oxyginase (COX). There are two well known version of COX called COX1 & COX2. COX 1 is important for blood clotting and mucus production. COX2 is important in pain and inflammation.
For example, aspirin prefers to inhibits COX1 and you get a strong anti-clotting but less pain reduction. NSAIDs that target mostly COX2 (Celecoxib) are great for pain and avoids harming the gut (COX1 inhibition dries up the gut mucus and lead to ulcers). Most NSAIDs fall somewhere in the middle and inhibit both COX1 and COX2 to different extents.
This is a *gross* over-simplification and its much more complex. But, there's a lot of good info on the internet about the topic.
👍👍👍👍👍
It irritates me when people don't wear masks properly, The mother does not cover her nose with the mask
Masks don’t work anyway
She is wearing it properly as you can see when she talks it slides down which happens often
Of All The Shit In This Video You Point Out The Mask🤭🤣🤣🤣🤣