A 36-year-old man with nut allergy experiences wheezy, lightheaded symptoms after eating at a restaurant. What is the most appropriate immediate action?

A 36-year-old man with nut allergy experiences wheezy, lightheaded symptoms after eating at a restaurant. What is the most appropriate immediate action?

• A. Administer adrenaline to the patient immediately
• B. Administer antihistamines immediately
• C. Use a bronchodilator inhaler first
• D. Call for help and wait for symptoms to worsen

Answer: (A)

Immediate recognition that this is a suspected anaphylactic reaction from a nut allergy highlights the need for rapid, life-saving treatment. Adrenaline (epinephrine) given by intramuscular injection is first-line therapy because it acts on multiple fronts at once: it constricts blood vessels to raise blood pressure and reduce swelling in the airways, it relaxes bronchial smooth muscle to relieve bronchospasm, and it dampens the release of further mediators from mast cells. This combination can quickly reverse airway obstruction and prevent progression to shock, which is why giving adrenaline now is the best action. After administering adrenaline, call for emergency help and monitor the patient closely, with readiness to repeat the dose if symptoms persist or recur. Antihistamines may help with itching or hives but do not reverse airway compromise or hypotension, so they aren’t appropriate as the initial treatment. A bronchodilator inhaler can help with wheeze but does not address the systemic aspects of anaphylaxis and should not be relied on as the sole initial step. Waiting for symptoms to worsen is dangerous; act promptly with adrenaline.

Immediate recognition that this is a suspected anaphylactic reaction from a nut allergy highlights the need for rapid, life-saving treatment. Adrenaline (epinephrine) given by intramuscular injection is first-line therapy because it acts on multiple fronts at once: it constricts blood vessels to raise blood pressure and reduce swelling in the airways, it relaxes bronchial smooth muscle to relieve bronchospasm, and it dampens the release of further mediators from mast cells. This combination can quickly reverse airway obstruction and prevent progression to shock, which is why giving adrenaline now is the best action.

After administering adrenaline, call for emergency help and monitor the patient closely, with readiness to repeat the dose if symptoms persist or recur. Antihistamines may help with itching or hives but do not reverse airway compromise or hypotension, so they aren’t appropriate as the initial treatment. A bronchodilator inhaler can help with wheeze but does not address the systemic aspects of anaphylaxis and should not be relied on as the sole initial step. Waiting for symptoms to worsen is dangerous; act promptly with adrenaline.