A 29-year-old Sally presents to the ED after experiencing sudden onset of itching and a widespread urticarial rash after about 20 minutes since eating at a restaurant. She reports that the meal may have contained shellfish, which she has never knowingly consumed before. Soon after the meal, she felt her throat was “tight” and experienced a sensation of chest discomfort, accompanied by palpitations and rapid breathing.
Paramedics were called and arrived to find her anxious, with a respiratory rate of 26, heart rate of 112 bpm, and blood pressure of 118/75 mmHg. Oxygen saturation was 98% on room air. She was given antihistamines en route to hospital but did not receive adrenaline, as she remained hemodynamically stable and did not exhibit stridor or wheeze.
On arrival to the ED, Sally continues to appear agitated, breathing rapidly, and scratching at her arms and neck. No swelling of the lips, tongue or airway is noted and she is speaking in full sentences.