Anita Garcia, 17 years old, and her roommate Rosa Rosario were celebrating a friend's birthday at a dessert buffet at a local restaurant when Anita developed acute dyspnea, and angioedema

Question

She complained of an itchy rash, and then had difficulty swallowing. Rosa drove Anita to the emergency room two blocks away rather than wait for an ambulance. As they approached the hospital, Anita lost consciousness. This medical emergency would most probably result in immediate _____ before any subsequent treatment.
a. subcutaneous injection of epinephrine
b. intravenous injection of corticosteroids
c. intravenous injection of antihistamine
d. intravenous injection of antibiotics
e. intravenous injection of a nonsteroidal anti-inflammatory drug.

Answer 1

Rationale: The correct answer is a. This is a case of anaphylactic shock caused by a food allergy. Anita's sudden onset of shortness of breath, swelling of mucosal tissues causing difficulty in breathing, and rash are characteristic of a type I hypersensitivity reaction after the rapid absorption of allergen into the bloodstream and systemic activation of mast cells in the connective tissue of blood vessels. Given the life-threatening nature of this medical emergency, where asphyxiation due to constriction of the airways and swelling of the epiglottis may occur, immediate suppression of Anita's hyperactive response is warranted. Subcutaneous injection of epinephrine will bring the most immediate effect, not corticosteroids, antihistamines, antibiotics, or nonsteroidal anti-inflammatory agents. Epinephrine will relax bronchial constriction, stimulate the heart, and induce the reformation of tight junctions between vascular endothelial cells, which will alleviate swelling and restore blood pressure.