Case Study Analysis: Allergic Reaction Treatment in Primary Care

This case study explores the management of a severe allergic reaction in a 17-year-old female who experienced anaphylaxis after consuming peanuts. The case highlights the critical role of primary care in addressing allergic reactions, particularly in rural settings where access to specialized care may be limited. The study details the patient's symptoms, the initial emergency response involving epinephrine administration, and the subsequent discussion of alternative treatments like antihistamines and corticosteroids. It examines the barriers to effective care, including cultural beliefs and socioeconomic factors, and emphasizes the importance of healthcare professional collaboration, particularly with cardiologists and dermatologists in managing the patient. The paper also reviews the benefits of primary care practices in rural areas, such as increasing awareness of hypersensitivity reactions, and the impact of these practices on economic performance and disease burden. The study concludes by advocating for further research into alternative therapies and evaluation techniques to improve allergic reaction management in primary care, while also considering the significance of informed consent and the use of nursing tools in evaluating treatment effectiveness.

Running head: ALLERGIC REACTION USING PRIMARY CARE MANUAL
Allergic reaction using primary care manual
Name of the student:
Name of the university
Author note:

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ALLERGIC REACTION USING PRIMARY CARE MANUAL
Introduction:
Allergic disorders such as hay fever, anaphylaxis, and asthma are now affected grossly
25% of the individual in advanced countries. However, the prevalence of the allergic reaction,
especially within children or teenagers is higher in rural areas compared to those who lived in a
developing area of countries (Mackey et al., 2016). The term allergy defined as the abnormal;
adaptive immune responses that either caused by allergen-specific IgE or caused by do not
involve. Although the increased occurrence of allergy observed in developing countries,
Epidemiological studies conducted so far stated that the frequency of developing allergies from
food, pollen or any other sources also prevail in rural areas and it is increasing gradually due to
lack of awareness and improved health care sectors in rural areas (Itoh et al., 2015). Moreover,
management of the allergic patient in the population is becoming more difficult because of
increased prevalence and complexes. Although general practitioners are expected to play the
crucial role in managing the allergic reactions, they are often ill-equipped for managing the
allergic reaction. According to Tsukamoto, Yamamoto and Makino (2014), when allergic
reactions become serious, the only effective drug for treating the allergy is epinephrine. Injection
of epinephrine within the minute can save the lives of children or teenager (Itoh et al., 2015).
However, there are certain barriers to using epinephrine in managing patients who are coming
from remote or social areas. Therefore, this paper will illustrate a case study of allergic reaction
which is treated by Primary Clinical Care Manual".
Discussion:
In primary care setting, women of 17 years with severe allergic reaction came in the
emergency room due to consumption of peanut. On arrival, emergency personal noted diffuse
and severe urticarious on patient’s arm, leg, face and severely observed around the mouth and

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eyes. During taking histories from the parents of the patient, they stated that she was having
lunch with family members when she was experiencing trouble in breathing and wheezing within
few minutes. Her parents stated that she was also exhibited the signs and symptoms confusion
and slurred speech. During transportation to the hospital, she was experiencing server-breathing
problem, immediately become unconscious and when she arrived at the hospital, pulse rate -100
beats per minute and upper airway obstacles were observed. Since it was not known allergy, she
was unaware of the reactions, which in turn threaten her life. After diagnosis, the health
professional with collaboration with dermatologist and cardiologists suggested that epinephrine
therapy but due to cultural beliefs, her parents refuse to adhere to the treatment procedure.
However, lastly, it was injected into the patient for faster recovery.
In recent years, it is clear that the burden of the disease associated with allergic disorders
reflects the long-term consequences of chronic allergic inflammations at the sites of repeated
exposure of allergen. A study Machado-Alba et al. (2017), suggested that food allergy by
consuming peanut is one if the common cause of anaphylaxis. Anaphylaxis encompasses a
Variety of the signs and symptoms where the diagnosis is largely based on history and physical
findings. According to Conte et al. (2014), the common form developed by food allergen which
developed IgE mediated reaction to the food such as peanut. it accompanied by inflammations
and induced by cellular components such as T cells and eosinophils. Patients with IgE associated
with the food allergy can be based on on the detection of food allergen-specific IgE in the serum
and body fluids. According to Lee and sun (2017), every three minutes a food allergy reactions
sent someone in the emergency room. Each year approximately 40% of the individuals are
affected by consuming foods such as prawn, peanuts or due to inhalation of pollen. In the year
between 1990 and mid-2000, the hospitalization rate due to allergic reaction and anaphylaxis was

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tripled compared to the prevalence observed in other years (Xu & Dou, 2015). Once serious
allergic reactions are starts, epinephrine is proved to be most effective therapy for managing the
reactions. Nurses have a major role in the routine care of patients with an allergic reaction. In the
above case study, nurses injected the epinephrine to the patient since its actions on the alpha
androgenic receptors, epinephrine lessen the vasodilatation and increased vascular permeability,
which occurred during food allergy (Cho & Kwon, 2018).
Rural residents often experienced barriers to the primary health care that limited their ability to
seek professional support. Poor socio-economic status of the individual in the rural area plays the
huge role in current primary care nurse’s practices since a majority of the individuals do not seek
professionals help in allergic reactions in the rural area which in turn increase the global burden
of the disease (Health.qld.gov.au. , 2018). The reason behind it is majority of the individualism
in rural area believed in traditional healers and thereby, they do not seek help from the primary
care setting of local area as observed in this case study (Weber et al., 2018). In the cases study,
the parents of the patients were apprehensive about epinephrine therapy and at first, they refused
to seek help. Even if they seek help from the local primary care practitioners, due to certain
cultural beliefs and mindset, they refuse to agree for treatment procedures involving epinephrine,
which in turn worsen the allergy-related disorders in rural areas (Weber et al., 2018). Other
factors such as unpredictable linguistic, educational disparities, lack of availability of resources
to support personnel, lack of facilities impacted the nurse' practices of administrating epinephrine
in the primary care setting (Cho & Kwon, 2018).
A study by McWilliam et al. (2018), stated that although epinephrine is the drug of
choice in the majority of the primary care setting, restricted services and vary in equipment for
the practice, impacted the primary care nurses practices. The Rural Health Support, Education

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and Training (RHSET) report also suggested that practice in the rural area is not standardized;
lack of clinical governance, lack of accurate protocols, profession role statement and lack of
multidisciplinary team also affected the practices (Machado-Alba et al., 2017). Therefore, it
influenced the consumers as well as practitioners. However, although there are certain barriers of
the practices, the primary care nursing practices in the rural area is beneficial for the consumers
who experienced server allergic reaction due to lack of awareness or environment full of
allergen. During the treatment procedure in the primary care setting, the practice helps rural
people to acquire basic knowledge about hypersensitivity reactions and risk factors of developing
hypersensitivity reactions (McWilliam et al., 2018). Therefore, they will be aware of consuming
any food that might contribute to hypersensitivity reactions. Furthermore, practitioners also
benefited from the practice in the rural area since it will improve the economic performance of
the health care sectors, reduce the burden of the disease and mortality rate in the rural areas. A
study by McWilliam et al. (2018), also suggested that since the economic status of the majority
of the individuals has the lower socioeconomic status they refuse to seek professionals helps and
administration of epinephrine. Epinephrine twin pack in Australia costs $38, which remain stable
from the 1990s (Machado-Alba et al., 2017). However, due to socio-demographic positions,
individual in rural areas cannot afford to pay for the treatment procedures. There is a power
imbalance also observed between nurses and patient, patient and doctor, nurses and doctor.
Power struggler mostly in the relationship between nurses and patient along with nurses and
doctors are patient and nurse’s respectively (Tobiano et al., 2016). The reason behind such a
relationship is that patients lack accurate knowledge about the area of concern and nurses do not
have sound knowledge about big medical terms (Greenhalgh et al., 2015).

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Apart from the primary care setting, cardiologist and dermatologists are involved in this
case since the patient was unconscious and her upper airway tract was blocked, any
administration of the medication should be done after consultation with cardiologists and
dermatologists. As observed in this case study, the patient was experiencing wheezing due to the
allergic reaction of peanut, the nurses and health professionals consulted a cardiologist for the
heartbeat of the patient, before administrating epinephrine (Tobiano et al., 2016) . The
dermatologist evaluated her symptoms nod allergies spreader in the face and then agreed to give
epinephrine for immediate management of the patient.
According to McWilliam et al. (2018), a potential alternative of epinephrine is
antihistamines and corticosteroids for management of anaphylaxis. The primary mechanisms of
antihistamines are that it believed to act as the competitive antagonism of histamine binding to
cellular receptors especially receptor H1 which are situated in the nerve endings, smooth
muscles, and glandular cells. Histamine receptors are consisting of H1 or H2 and the
antihistamines act upon any of the receptors to reduce the effect of released histamines from the
immune cells. According to McWilliam et al. (2018), the rationales for using antihistamines are
they are second-line drugs that manage allergy after immediate stage of management. According
to Machado-Alba et al. (2017), they are not life-saving medicines and therefore it does not use
for initial treatment but it is effective if epinephrine is not present. No evidence supported the use
of H1 antihistamines in anaphylaxis, which relieves itching, flushing, urticarious. A study also
suggested that it does not act on the obstacles airway or hypotension is caused by allergic
reactions. Corticosteroids are also used for managing the allergic infections since it lessens the
swelling, itching and redness (Tobiano et al., 2016). Therefore, further research required in the
domain of the hypersensitivity reactions where antihistamines manage the severe allergic

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reactions by primary care practitioners and training required for accurate administrations of the
antihistamines. Although the cost of epinephrine’s and antihistamines are similar in some cases
where the patient has blocked airway ad high heart rate, antihistamines are effective
(Health.qld.gov.au., 2018). As observed in this case study, the patient has an increased heart rate
due to allergic reactions; antihistamines can be administrated instead of the epinephrine for
avoiding increased heart rate. Moreover, these drugs also have mild side effects such as
confusions, hypotension. H1 antihistamines are more secured to used for the patients with
allergic reactions rather than H2 histamines(Cho & Kwon, 2018) .Further research also required
for administration of H2 histamines in primary care setting for managing allergic reactions,
proper knowledge of the acquired. Medical practitioners, nurses or other healthcare staffs can
evaluate the evaluation of such drug administrations. The evaluation procedure is thorough
monitoring of the patient time to time in order to notice the improvement of patients such as
normal heartbeat, clear heartbeat, and normal skin without any allergic symptoms (Kaminaka et
al., 2014). Informed consent should be obtained from the patient for the treatment procedures.
Another evaluation can be done by observing patients or communicating with them about their
feels after administration of drugs.
Since the alternative therapies such as antihistamines and corticosteroids are not effective
as administration of epinephrine, further evaluation techniques need massive analysis for
obtaining the efficiency of the antihistamines. Moreover, a considerate number of individuals are
unaware of the effectiveness of antihistamines and no evidence was found that support the
effectiveness of antihistamines over epinephrine’s for practicing in the primary care setting
(Conte et al., 2014). Therefore, the study requires in that domain for alternative therapies.

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Moreover, the use of any device or nursing tools can be an effective way of evaluating the
effectiveness of potential alternative therapies such as antihistamines.
Conclusion:
Thus, it can be concluded that the global burden of the disease associated with allergic
disorders reflects the long-term consequences of chronic allergic inflammations at the sites of
repeated exposure of allergen. The case study represents the severe allergic reaction of 17 years
old women who consumed peanut in lunch. Emergency personal noted the diffuse and severe
urticarious on patient’s arm, leg, face and severely observed around the mouth and eyes. SHE
exhibited the signs and symptoms confusion and slurred speech. After diagnosis, primary care
nurses administrated her with epinephrine. Although it is an effective treatment, the majority of
the individuals from rural area refused to seek help due to their cultural beliefs, which increase
the burden. Alternative therapies such as antihistamines can be used for the patient with an
allergic reaction but no evidence found that support the effectively more than epinephrine.
Therefore, further research and evaluation required in the domain for accurate nursing
interventions.

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