A 16-year-old boy presented to the clinic with symptoms of strep throat including a sore throat for 3 days. On examination, he exhibited signs of strep throat including tonsil swelling and exudate. A rapid strep test was positive, confirming strep throat. He was prescribed penicillin but had an anaphylactic reaction. This type of severe allergic reaction is caused by IgE antibodies produced in response to environmental allergens like penicillin, which is a fungus. While he had no known drug allergies, he likely had a previous sensitization to penicillin that caused the anaphylactic reaction upon administration.

1. Advanced patho
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Stacy Adam
Wk 1 Discussion
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Wk1 Discussion 6501
The 16-year-old boy in the discussion scenario presented to the
clinic with specific complaints that are common in Strep Throat
infection. He complained of a sore throat for 3 days. He denied
recent cold, influenza, ear infections, or allergies. Redness, +3
tonsil edema, positive anterior and posterior cervical
adenopathy, low-grade temperature, and pharyngeal exudate
were noted by the practitioner on the exam. A diagnosis of
Strep Throat was confirmed by a positive rapid strep throat
culture. Penicillin was prescribed.
Strep Throat is not a genetic disorder, but an infectious one
caused by A. Streptococcus bacteria. It is not gender-specific.
Strep throat most commonly occurs during the late winter or
early spring months as a direct result of people being grouped
closely together indoors allowing it to spread easily via direct
contact (American Academy of Family Physicians, 2016).
The patient’s symptomology and positive culture confirm that
he was infected by A. Streptococcus bacteria. His body’s
response to A. Streptococcus bacteria is the body’s initial
inflammatory response to this bacteria; redness, swelling, heat,
and pain (Kahn Academy, 2010). The patient’s anaphylactic
response to penicillin was mediated by ‘IgE antibodies that are
produced by the immune system in response to an
environmental allergen’ (Justiz-Vaillant & Zito, 2019). These
allergens include pollens, animal dander, dust mites or fungi
(Justiz-Vaillant & Zito, 2019). The patient’s anaphylactic

2. response to penicillin, a fungus, was unknown prior to its
administration.
When a bacterial infection occurs, the body releases mast cells
that are activated by chemokines to attack the infection (Kahn
Academy, 2010). Histamine is released causing vasodilation
(Kahn Academy, 2010). Endothelial cells are pushed apart and
capillaries become larger and dilated, causing swelling to occur
(Kahn Academy, 2010). The capillary walls become more
porous allowing more cells to pass through them (Kahn
Academy, 2010). Neutrophils act as the first responders and are
attracted to the chemokines (Kahn Academy, 2010). They roll
along the endothelial wall, squeezing through to eat up bacteria
and damaged cells (Kahn Academy, 2010). Specific action via B
and T cells are also activated to attack and destroy the bacteria
(Kahn Academy, 2010).
The patient's anaphylactic response, Type I hypersensitivity
reaction, to IgE antibodies is produced by the ‘immune system
in response to environmental allergens’ (Justiz-Vaillant & Zito,
2019). If left untreated, it can result in a life-threatening or
irreversible injury that includes death (Justiz-Vaillant & Zito,
2019). While the patient did not have a known allergy and it
was disclosed that he had none, Type I hypersensitivity
reactions occur after a previous sensitization (Justiz-Vaillant &
Zito, 2019). In a Type I hypersensitivity reaction, mast cells
quickly release a large amount of ‘histamine and later on
leukotrienes’ after encountering an allergen (Justiz-Vaillant &
Zito, 2019). This reaction can lead to ‘bronchospasm, laryngeal
edema, cyanosis, hypotension, and shock’ in the most severe
cases (Justiz-Vaillant & Zito, 2019).
References
American Academy of Family Physicians. (2016). Strep Throat.
Retrieved February 23, 2020 from https://eds-a-ebscohost-
com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=5&si
d=040cd3d9-4ef6-4b25-872f-592f1c7c030c%40sessionmgr4006

3. Khan Academy (2010, February 24). Inflammatory
Response/Human Anatomy and Physiology/Health &
Medicine [Video File]. Retrieved February 23, 2020
from https://www.youtube.com/watch?v=FXSuEIMrPQk%20%2
0
Justiz-Vaillant, A.A., & Zito, P.M. (2019). Immediate
Hypersensitivity Reactions. In StatPearls. Treasure Island, FL:
StatPearls Publishing. Retrieved February 23, 2020
from https://class.content.laureate.net/f6bf9251ee3c3f606fefa59
546a98a32.pdf
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The
biologic basis for disease in adults and children (8th ed.). St.
Louis, MO: Mosby/Elsevier.
Soo, P. (2018, July, 28). Pathophysiology Ch 10 alterations in
immune function [Video File]. Retrieved February 23, 2020
from https://www.youtube.com/watch?v=Jz0wx1-jTds
Sonia - Discussion Week 1 - Scenario 1
COLLAPSE
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Main Question Post
In an attempt to treat this patient's symptoms of strep throat, the
provider prescribed amoxicillin, an antibiotic, to treat the
bacteria that causes strep throat and manage the signs that the
patient is experiencing. According to Lockett, Huoman, and
Holloway, a family history of allergies is a risk factor for
individuals developing allergic reactions (2015). Mothers with a
history of hypersensitivity increase their child's risk factor of
producing the same allergies as them (Lockett, Huoman, &
Holloway, 2015). However, parents having an allergic reaction
does not mean that the child will have the same allergy or
experience the same response when exposed to allergens
(Cleveland Clinic, 2015). It appears that although it is common
for children to experience allergies when inherited from a
parent, an allergic response can decrease and diminish over time
(Shenoy et al., 2019). The patient in this scenario had a

4. genetically-linked anaphylactic reaction to the amoxicillin
prescribed.
According to the patient's medical history, there was no history
of known food or drug allergies and the patient was negative for
frequent infections as a child. This suggests that the patient had
no experience receiving penicillin-like antibiotics, so there was
no recent exposure to amoxicillin that would have allowed the
provider to anticipate the patient's response. This patient
experienced a severe allergic reaction because several body
systems displayed an immediate reaction to a drug with swollen
lips and tongue, difficulty breathing, and audible wheezes,
which are signs of anaphylaxis (Cleveland Clinic, 2015).
Anaphylactic reactions to amoxicillin, as a beta-lactam
antibiotic, is a standard Type 1 hypersensitivity reaction that is
IgE-mediated. IgE is an antibody that affects mast cells upon
exposure to the antigen, but the effect decreases over time
(Reber, Hernandez, & Galli, 2017). According to Patterson and
Stankewicz, the patient may have a less severe reaction to
amoxicillin in the future if this antibiotic is avoided for an
extended time (2019).
Conclusion
If this patient scenario reported an adverse family history of
allergies to penicillin-like drugs, although the research has
found a connection, I would not stress the significant risk of
inheriting drug allergies from parents. I believe this was a Type
1 hypersensitivity response to amoxicillin (Reber, Hernandez, &
Galli, 2017). If the patient had a prior history of taking this
antibiotic, I would not maintain my belief that this was a Type 1
response due to the critical nature of this reaction without prior
warning.
References
Cleveland Clinic. (2015). Allergies in children. Retrieved from
https://my.clevelandclinic.org/health/diseases/13080-allergies-
in-children
Lockett, G. A., Huoman, J., & Holloway, J. W. (2015). Does
allergy begin in utero? Pediatric Allergy and Immunology, 26,

5. 394–402. doi: 10.1111/pai.12408
Patterson, R. A., & Stankewicz, H. A. (2019). Penicillin
allergy. StatPearls [Internet]. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK459320/
Reber, L. L., Hernandez, J. D., & Galli, S. J. (2017). The
pathophysiology of anaphylaxis. The Journal of Allergy and
Clinical Immunology, 140(2), 335–348. http://dx.doi.org/doi:
10.1016/j.jaci.2017.06.003
Shenoy, E. S., Macy, E., Rowe, T., & Blumenthal, K. G. (2019).
Evaluation and management of penicillin allergy: A
review. Journal of the American Medical Association, 321(2),
188-199. http://dx.doi.org/doi: 10.1001/jama.2018.19283
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