9/9/2023 0 Comments Cross reactivity allergyFinally, recent evidence suggests that severe biphasic reactions are extremely rare (more on this in the SGEM podcast with Dr. The patient improved “within minutes” of receiving diphenhydramine and subcutaneous epinephrine, which may suggest a dystonic reaction which promptly responded to diphenhydramine. A dystonic protruding tongue could easily mimic an edematous tongue. The patient's tongue and uvula were described as edematous, but there was no note of edema involving the lips or eyes. Although these authors propose that this patient had biphasic angioedema, it may be more likely that he was suffering from acute dystonia. The following day he presented to the ED with recurrent tongue swelling which responded to diphenhydramine and epinephrine. Kahlon described a 29-year-old man who received intramuscular haloperidol with subsequent tongue swelling that responded to oral diphenhydramine. There are two reports of angioedema following haloperidol administration, only one of which is described in detail ( Kahlon 2012, Muzyk 2012 ). Haloperidol was removed from his allergy list, and he was promptly stabilized and transferred out of the ICU. He tolerated this well with improvement in his agitation. Eventually, following literature review and discussion with the ICU pharmacist, the ICU team administered a dose of haloperidol. He was deemed too unstable to transfer to any other location in the hospital. This process continued for days, with security frequently called to the ICU and some nurses injured. Lorazepam was only transiently effective, and he continued to have frequent episodes of violent agitation. Psychiatry recommended avoiding all neuroleptic medications, using lorazepam instead to treat his agitation. Unfortunately, his electronic medical record indicated that he had a history of anaphylaxis from haloperidol (no further details available). After exclusion of an acute medical or neurologic process, it became clear that he was suffering from schizophrenia with medication nonadherence. Once upon a time at Genius General Hospital, a 25-year old man was admitted to the ICU for agitation.
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