Case Challenges

Quiz

145Allergology
A 58-year-old man presented with recurrent angioedema and dyspnea following consumption of pork or beef. Until three years ago, he had never experienced adverse reactions after meals. Beginning two years ago, when he consumed beef, pork, or goat meat, urticaria appeared approximately 3-4 hours later, followed rapidly by angioedema, dyspnea, nausea, and vomiting. One month ago, he presented to the emergency department four hours after eating pork with angioedema, dyspnea, and dizziness, and was diagnosed with anaphylaxis associated with hypotension. He resides in a rural area and engages in hillside farming as a weekend hobby. Three years ago, he sustained an insect bite on his leg-presumably from a tick-resulting in a rash and small nodular scarring. He reports no symptoms following consumption of other foods; duck and chicken cause no adverse reactions. What is the most likely diagnosis?
128Allergology
A 52-year-old woman with a history of pulmonary tuberculosis began combination therapy with isoniazid (INH), rifampin (RFP), pyrazinamide (PZA), and ethambutol (EMB) one month prior. Three days before presentation, she developed a fever over 38°C accompanied by tonsillar swelling. Believing it to be a common cold, she self-administered antipyretics as needed for fever. One day before admission, she noticed a worsening, generalized pruritic erythematous rash. Her pruritus intensified, and she developed facial edema, leading her to seek emergency care. On examination, she was found to have bilateral cervical lymphadenopathy. Chest imaging, laboratory evaluation, and detailed assessment of the rash were performed.

What is the most likely diagnosis?
121Allergology
A 20-year-old woman presented to the emergency department with facial edema, throat tightness, and abdominal pain that began seven days ago. These symptoms have been recurring for seven years, requiring repeated emergency department visits each time. Her blood pressure remained stable during episodes, but she frequently experienced intermittent dizziness. Her symptoms did not improve immediately with systemic steroid treatment and showed gradual resolution over days. Over the past three years, she has experienced swelling of multiple joints, particularly the interphalangeal joints of her fingers, accompanied by paresthesia, but these symptoms have not responded to treatment.

Initially, she suspected the attacks were triggered by consuming peach, soy milk, or coffee, but in recent years the episodes have occurred regardless of food intake.
Her mother also frequently visits the emergency department for intermittent abdominal pain.
Physical examination during outpatient clinic visits was unremarkable. The following laboratory findings were obtained.

Which medication is most effective for immediate use when this patient again develops abdominal pain, dyspnea, and facial edema?