Clinical immunology question Mr. R.M., a 60-year-old Caucasian man, was stung by a bee while gardening. He had been stung once before earlier in the summer. Within a few seconds, his hand began to itch and he began to experience abdominal cramping. He subsequently began experiencing difficulty breathing. Fortunately, he was able to reach a first aid kit in his garage. Inside of the kit was an EpiPen (injectable epinephrine) that his wife kept for herself because she was allergic to bee venom. He immediately had his wife drive him to the hospital. He was asymptomatic on arrival at the hospital. R.M. had no history of adverse reactions to bee venom or antibiotics. Because of the nature of the incident, a diagnosis of anaphylactic shock due to bee venom sensitivity was made. An IgE level was ordered. The results indicated a level more than twice the (normal) reference range value. In addition, a follow-up skin test was performed. The patient was extremely positive for bee venom. Questions: 1.Which of the 4 types of hypersensitivity reactions does this case represent? 2.What is the immunologic mechanism involved in anaphylaxis? 3.What types of agents can induce anaphylactic shock? 4.Describe 2 different types of testing to diagnosis this patient. 5.What is the risk in performing a skin test? Solution Answer: 1) There are four types of hypersensitivity reactions, they include: 1) Type - I ; Allergy , 2) Type- II ; Cytotoxic, antibody-dependent, 3) Type III; Immune complex disease 4) Type IV; Delayed-type hypersensitivity. 2) Anaphylaxis is an Type-I reaction ; allergic reaction. During allergic reaction, IgE react with antigen, and it activates basophils and mast cells, due this activation, histamines are released. 3) Anaphylactic shock could be due to the food agents such as milk, eggs and shellfish. In few cases, insect stings can cause shock. 4) Diagnosis includes, 1) Allergy testing (skin allergy test), 2)Differential diagnosis. 5) Skin test is available only to test effect of penicillin drug allergy.so, it is risk for allergies..