Case Study on Drug-Induced Anaphylaxis: Jim Palmer's Reaction

This case study focuses on a 53-year-old farmer, Jim Palmer, who experienced a severe anaphylactic reaction after receiving flucloxacillin for cellulitis. The study details his presentation in the emergency department, including the development of urticarial rashes, respiratory distress, and a drop in blood pressure. It highlights the ISBAR handover framework, outlining the situation, background, assessment, and recommendations for immediate epinephrine administration and serum tryptase testing. The case emphasizes the importance of recognizing and managing drug-induced anaphylaxis, discussing diagnostic procedures, including the limitations of laboratory tests, and the critical role of early intervention with epinephrine. The study also underscores the need for careful administration of antibiotics, considering the patient's medical history and potential cross-reactivity of drugs to prevent hypersensitivity reactions. References to current research are provided to support the case study's findings.

Running head: CASE STUDY ON DRUG INDUCED ANAPHYLAXIS
CASE STUDY ON DRUG INDUCED ANPHYLAXIS
Name of the Student
Name of the university
Author’s note

1CASE STUDY ON DRUG INDUCED ANAPHYLAXIS
DRUG INDUCED 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

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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.

3CASE STUDY ON DRUG INDUCED ANAPHYLAXIS
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

4CASE STUDY ON DRUG INDUCED ANAPHYLAXIS
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.
ISBAR HAND OVER FRAMEWORK OF JIM PALMER
Identification:
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.
Situation
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

5CASE STUDY ON DRUG INDUCED ANAPHYLAXIS
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.
Background
No such past history of allergic reaction has been noted. Jim was not under any medication.
Assessment
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.
Recommendation
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

6CASE STUDY ON DRUG INDUCED ANAPHYLAXIS
(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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