Thursday, October 20, 2011

Drug Allergy

I was working in an urgent care clinic when I walked into one of the exam rooms to see a new patient. 
“So what brings you into be seen?” I asked.
“I’m having a problem with my tongue and lips.  They seem to be swelling somewhat,” Curt said. 
“Okay, anything else?”
“No, just this weird feeling in my lips and tongue, it’s feels as though its tingling,” Curt stated as he sat on the exam table. 
“Are you by chance on a blood pressure medication?”
“Yes, I take a medicine I believe it’s called enalapril, “ replied Curt. 
“How long have you taken it?”
“My doctor put me on it about two weeks ago.”
“Well it sounds as though you’re having a side effect to your blood pressure medication, you’re on what we call an ACE inhibitor.  One of it’s side effects is it can cause swelling of the face, more specifically the mouth, lips, throat, nose area.  We call it angioedema.”
“Are you on any other medications?”
“No, just that one.”
I quickly finished taking Curt’s personal medical history, his family history and did not find anything else that would have caused his problem.  His physical exam was normal except some mild swelling of his lips which were a little redder than normal and possibly some mild swelling of his tongue, seeing that his tongue edges were beginning to encroach upon his bottom teeth. 
“Okay, Curt you need to stop taking your blood pressure medication, you’re allergic to it.  I need you to call your primary care physician in the morning and advise him that you have had an episode of angioedema due to your enalapril.  He’ll have to start you on a different blood pressure medication.  In the meantime, I need you to start taking some zyrtec, which comes over the counter once a day for the next 3 days.  That should be enough anti-histamine to make your mild amount of swelling go away.  Any questions?”
“Nope, I think I got it.  Do I just ask the pharmacist for some zyrtec?”
“You can, or you’ll find it in with other allergy medications, it should be in a green container, it’s a 10 mg. dose.  Got that?”
“Yep, thanks for you help.”
“Not a problem, enjoy the rest of your week.”

  Angioedema can be caused by many things, cold temperatures, drugs, allergies to shellfish, hereditary (family gene), and vibrations.  It causes swelling of the skin layers: subcutaneous and dermal layers, usually due to histamine release.  Typically patients are treated with anti-histamines (to block the histamine release), and/or steroids.  If it’s a severe case (such as life threatening, patient’s airway is potentially threatened from the swelling) then they are given epinephrine sub-cutaneously and are treated in an emergency room. 

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