Sample Case
18 mo female ED patient with urticaria 2/2 to amoxicillin allergy.
-Allergy to amoxicillin discovered 3mo PTE (Prior to encounter) evidenced by a diffuse rash that took three weeks to resolve.
-She travelled out of the country and is given amoxicillin under a different brand name the parents didn’t recognize to treat an ear infection. The patient took it for 5 days and came with a severe, diffuse urticaria rash that covered about 80% of her body. She had been placed on Benadryl and steroids for one day PTE and the parents reported that the rash foot worse in that one day.
-Significant pruritus and patient scratching during the encounter.
Treatment
-Counseled patient about the likely morbidity and mortality of future allergic responses to amoxicillin.
-Switched Benadryl to Cetirizine once daily and less sleepiness.
-Add Famotidine
-Continue po prednisone for the entire 5 days.
-F/u with PCP in 24 hours.
The worsening rash is likely the natural progression of the urticaria and not because the Benadryl and steroids weren’t working.