A 16-year-old boy comes to the clinic with a chief complaint of a sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections, or pneumonia. NKDA or food allergies. Physical check reveals temp of 99.6 F, pulse 78, and regular with respirations of 18. HEENT normal with exception of the reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. The rapid strep test performed in the office was positive. His HCP wrote a prescription for amoxicillin 500 mg PO q 12 hours x 10 days #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.
- The role genetics plays in the disease.
- Why the patient is presenting with the specific symptoms described.
- The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
- The cells that are involved in this process.
- How another characteristic (e.g., gender, genetics) would change your response.
Expert Solution Preview
Introduction:
In the given scenario, a 16-year-old boy with a positive rapid strep test was prescribed amoxicillin by his healthcare provider. However, post the administration of the first capsule, the patient developed an allergic reaction that required emergency treatment. The following discussion addresses various aspects related to this scenario.
1. The role genetics plays in the disease:
Genetics plays a significant role in determining an individual’s susceptibility to allergies. In the case of the above patient, there may be an underlying genetic predisposition towards developing an allergic reaction to amoxicillin or other similar antibiotics. This predisposition may be inherited from parents or acquired through mutations in genes involved in immune response regulation.
2. Why the patient is presenting with the specific symptoms described:
The patient is presenting with a sore throat, fever, and swollen tonsils with white exudate due to an infection caused by Streptococcus pyogenes. Post antibiotic administration, the patient developed an allergic reaction that resulted in swelling of his tongue and lips and difficulty breathing with audible wheezing. These symptoms are typical manifestations of an acute hypersensitivity reaction, triggered due to amoxicillin use.
3. The physiologic response to the stimulus presented in the scenario and why you think this response occurred:
Allergic reactions involve an immune response that is triggered when the body perceives a foreign substance as harmful. In the case of the patient, amoxicillin acted as the stimulus that stimulated an immune response in the body, leading to the release of histamine and other inflammatory mediators. This response resulted in the characteristic symptoms of an allergic reaction, such as swelling of the tongue and lips and difficulty breathing.
4. The cells that are involved in this process:
Cells involved in the physiologic response to an allergic reaction include mast cells, basophils, and eosinophils. These cells express receptors for IgE antibodies that bind to antigens present on the surface of the allergen. This binding leads to degranulation of these cells, resulting in the release of mediators of inflammation, such as histamine, leukotrienes, and prostaglandins. These mediators cause the characteristic symptoms of an allergic reaction.
5. How another characteristic (e.g., gender, genetics) would change your response:
The response to an allergic reaction may vary depending on various factors such as the gender of the patient, their genetic makeup, and other underlying conditions. For instance, females are more likely to experience allergic reactions than males. Genetic predisposition may influence the severity of the allergic reaction or the type of medication that the patient may require. These factors must be considered while managing patients with allergic reactions.
