J. E., a 37-year-old woman with no prior history of allergies, was working in her yard when she received a sting on the right wrist from a yellow-jacked wasp. Several minutes later she complained of a itching sensation and cramping abdominal pains. She then became acutely short of breath with wheezing. A patchy erythema radiating from the area of the sting was noted along with swollen eyelids and lips. A neighbor took her to the hospital where she became very faint and could not talk or provide information to assist with a diagnosis. Vital signs were as follows: BP of 60/34; Pulse of 156; Respiration rate of 40 Epinephrine 1/1000 was administered IM along with 100 mg of hydrocortisone. Within minutes, an improvement in the respiratory rate was noted and blood pressure increased to 100/70 with a pulse of 112.

QUESTIONS:

1) What type of hypersensitivity response is described above? Go through the process of how this hypersensitivity reaction occurs starting with the initial exposure and then a subsequent exposure; be specific?

2) Explain the rationale for each of the following signs and symptoms

a) Pruritus

b) Increased pulse

c) Difficulty talking and breathing

d) Feeling faint

e) Erythema

f) Low BP

3) What is the rationale for treating the patient with 100 mg of hydrocortisone and an IM injection of epinephrine? Include in your discussion how each of the treatments alleviates the signs and symptoms

4) Why is it important for the patient to carry an EpiPen with him and wear a Medic-Alert bracelet? Suggest several situations the patient should avoid to reduce the risk of future stings