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Allergy

  • Common ddx

    • seasonal allergies, pollen allergy, food allergy, cat allergy, dust mite allergy, allergic rhinitis, drug allergy, allergies
  • Serious ddx

    • anaphylaxis
  • ER tx

    • if dyspnea, airway swelling: epinephrine 1:1000 0.3-0.5 mg IM q5min prn for dyspnea
    • IV saline 1-2L for hypotension
    • steroids (prednisone 60 mg PO. If severe use methylprednisone 126mg IV)
    • diphenhydramine 50 mg IV
    • if asthma or wheezing, give albuterol 2.5mg neb
    • discharge if asymptomatic for 4 hours. Admit if unstable.
    • discharge meds: diphenydramine, prednisone 50mg 1 tab PO qday x 5 days, epi-pen
  • Pediatric dosings

    • epinephrine 0.01 mg/kg
    • saline 10-20 mL/kg
    • prednisone 2 mg/kg PO, methylprednisone 2 mg/kg IV
    • diphenhydramine 1 mg/kg
  • Other ddx

    • asthma, mastocytosis
  • Sx

    • acute dyspnea, angioedema, urticaria
  • HPI

    • onset: acute vs chronic, new vs old
    • seasonality
    • severity
    • alleviation
    • aggravation, triggering factors
  • ROS

    • fever
    • skin: rash, urticaria, pruritus
    • head: sinus pressure
    • eyes: eye itch, lacrimation,
    • ENT: nose itch, runny nose, congestion, sneezing, sore throat, oral/facial edema
    • cardio: chest pain
    • pulm: dyspnea, cough, sputum
    • GI: diarrhea, nausea, vomiting
  • PMH

    • allergies to food, drugs
    • asthma
  • FH

  • SH

    • occupational exposure
    • pets at home
    • carpets
    • exposure to allergens
  • Meds

    • new meds
    • antibiotics
    • lotions
  • Allergies

  • Px

    • vitals: fever, BP
    • general and respiratory distress
    • skin: rash, urticaria, scratch marks, insect bite/sting marks
    • head: sinus tenderness, facial edema
    • eyes: conjunctivitis
    • ENT: mucosal membranes, edema, rhinitis, oral edema
    • cardio
    • pulm: stridor, wheezing

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