Laryngeal edema

Hydrogen bromide (HBr), a pale yellow to colorless gas, causes irritant and corrosive reactions in the tissues with which it comes in contact. Pulmonary edema laryngeal spasm have been reported and may be fatal. The toxicity profile ofthe bromine-containing trifluoiobiomomethane (CFjBr) reflects die general toxicity of fluorocarbons. 

III pruritus flush Urticaria angioedema (not mandatory) vomiting defecation diarrhea laryngeal edema bronchospasm cyanosis shock... 

Dyspnea (bronchospasm, laryngeal edema) Stevens-Johnson syndrome... 

The answer is a. (Hardman, p 224.) Epinephrine is the drug of choice to relieve the symptoms of an acute, systemic, immediate hypersensitivity reaction to an allergen (anaphylactic shock). Subcutaneous administration of a 1 1000 solution of epinephrine rapidly relieves itching and urticaria, and this may save the life of the patient when laryngeal edema and bronchospasm threaten suffocation and severe hypotension and cardiac arrhythmias become life-endangering. Norepinephrine, isoproterenol, and atropine are ineffective therapies Angioedema is responsive to antihis-... 

If a casualty is known to have inhaled vesicant vapors but does not display any signs or symptoms of an impacted airway, it may still be appropriate to intubate the casualty since laryngeal spasms or edema may make it difficult or impossible later. Reddening of the skin (erythema) and lesions are treated symptomatically. 

Drug-specific antibodies of the IgE type combine via their Fc moiety with receptors on the surface of mast cells. Binding of the drug provides the stimulus for the release of histamine and other mediators. In the most severe form, a life-threatening anaphylactic shock develops, accompanied by hypotension, bronchospasm (asthma attack), laryngeal edema, urticaria, stimulation of gut musculature, and spontaneous bowel movements (p. 326). 

Exposure to and inhalation of concentrations of 2500-6500ppm, as might result from accidents with liquid anhydrous ammonia, cause severe corneal irritation, dyspnea, bron-chospasm, chest pain, and pulmonary edema that may be fatal. Upper airway obstruction due to laryngeal/pharyngeal edema and desquamation of mucous membranes may occur early in the course and require endotracheal intubation or tracheostomy. " Case reports have documented chronic airway hyperreactivity and asthma, with associated obstructive pulmonary function changes after massive ammonia exposures. ... 

Voluntary inhalation of butane has led to numerous deaths. Possible mechanisms for the cause of death included the central respiratory and circulatory sequelae of the anesthetic properties of butane, laryngeal edema, chemical pneumonia, and the combined effects of cardiac toxicity and increased sympathetic activity. ... 

Because fluorine is the most reactive of the elements, free fluorine is rarely found in nature. Fluorine reacts with water to produce ozone and hydrofluoric acid. In humans, the inhalation of high concentrations causes laryngeal spasm and bronchospasm, followed by the delayed onset of pulmonary edema. At sub-lethal levels, severe local irritation and laryngeal spasm will preclude voluntary exposure to high concentration unless the individual is trapped or incapacitated. Two human subjects found momentary exposure to 50 ppm intolerable 2 5 ppm was tolerated briefly, but both subjects developed sore throat and chest pain that persisted for 6 hours. Short-term exposures to concentrations up to 10 ppm were tolerated without discomfort. ... 

Allergic states Control of severe or incapacitating allergic conditions intractable to conventional treatment in serum sickness and drug hypersensitivity reactions. Parenteral therapy is indicated for urticarial transfusion reactions and acute noninfectious laryngeal edema (epinephrine is the drug of first choice). 

The most frequently reported adverse reactions attributed to cromolyn sodium (on the basis of recurrence following readministration) involve the respiratory tract and include bronchospasm (sometimes severe, associated with a precipitous fall in pulmonary function [FEV- ]), cough, laryngeal edema (rare), nasal congestion... 

Hypersensitivity reactions Rare cases of anaphylaxis have occurred as well as rare episodes of hypersensitivity (eg, bronchospasm, laryngeal edema, rash, eosinophilia). 

Allergic symptoms include urticaria angioneurotic edema laryngospasm bronchospasm hypotension vascular collapse death maculopapular to exfoliative dermatitis vesicular eruptions erythema multiforme reactions resembling serum sickness (eg, chills, fever, edema, arthralgia, arthritis, malaise) laryngeal edema skin rashes prostration. 

Respiratory Conjunctivitis Rhinitis Asthma Laryngeal edema... 

Only nine allergic reactions to cuttlefish have been described (Caffarelli et ah, 1996 Ebisawa et ah, 2003 Shibasaki et ah, 1989). One patient was a 10-year-old female who experienced a severe reaction to ingestion of cuttlefish that was manifested by urticaria, angioedema, asthma, abdominal pain, laryngeal edema, and hypotension (Shibasaki et ah, 1989). SPT and RAST were positive. This patient reportedly tolerated octopus, clam, oyster, abalone, mussel, and scallop but reacted to crab and shrimp. Caffarelli et ah (1996) describe a 14-year-old female who had cuttlefish-dependent, exercise-induced anaphylaxis. Ebisawa et ah (2003) reported 7 cases of allergy to cuttlefish among a series of 305 pediatric cases of food allergy but provided no specifics on the circumstances or symptoms of these patients. 

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