The case study describes a 16-year-old male who was exhibiting symptoms of step throat and given amoxicillin, ultimately discovering this individual was allergic to penicillin. The male had no known drug history and was treated with the common medication for this disease. Had the patient had this diagnosis previously, the allergy would have been discovered a while ago and avoided at this age.
A group of immunologists at La Jolla Institute for Immunology (n.d) stated they believed recurrent strep throat has a genetic factor, and it was noted children had less B and Tfh cells to produce antibiotics to fight this particular disease. While this child has not had step throat before, he could be at risk of recurrent infections if he received a gene from his parents causing decreased immunity, as he does not have the proper antibodies to fight step throat. However, having the gene passed to him alone would not be the only cause of this disease. McCance and Huether (2019) discussed the occurrence genes interacting with their environment as a multifactorial trait, as the child must come into contact with the bacteria in order to uncover the gene (p.161). Other factors that may impact the increased incident of getting strep throat could be poor diet and poor hygiene.
Strep throat symptoms can vary from patient to patient. Strep Throat (2016) reported symptoms of step throat could include white or yellow spots in the back of the mouth, fever, sore and red throat, and swollen lymph nodes on the neck. According to the case study, the child had a sore, red throat with white spots, as well as swollen lymph nodes (cervical adenopathy). The practitioner had assessed the signs and symptoms and ordered a strep test, which had come back positive. McCance & Huether (2019) discussed the various ways the body protects itself, such as with physical barriers in the respiratory tract, goblet cells trapping bacteria and moving it to be expelled by coughing or sneezing, and through the inflammation process (191). The inflammation process means the body increases blood flow to the infected or injured site (redness), which causes swelling due to more fluid in one area (swollen lymph nodes), the swelling then causes pain (sore throat), and purulent exudate (white spots on tonsils) from a build up of white blood cells attempted to fight the bacteria (McCance & Huether, 2019, p.210). At times, the body may also raise its temperature to fight bacteria, hence the low-grade fever which can be high in some patients.
Amoxicillin had been prescribed to the child, as is with common practice for strep throat treatment. However, the practitioners did not know the child was allergic to this medication since he had not needed to take it in the past. Instead of allowing the drug to do its job and fight the bacteria, the body became hypersensitive to it and caused swelling, difficulty breathing, and wheezing. Torres et al. (2016) stated the IgE immune mechanisms are involved in response to allergic reactions, and for some reason with penicillin, the patient can become allergic to all penicillin (cross-reactive) or the body can be selective. Multiple cells are involved with the process of allergic reactions, as inflammation has caused the bronchial tubes and airway to start to close, as well as lip and tongue swelling. The decreased airflow through the lungs caused the wheezing. According to Warrington (2012), some of the cells involved in this type of reaction are basophils and mast cells, which encourage the release of inflammatory mediators. The mediators can trigger activation of other cells. Per McCance & Huether (2019), additional cells involved are phagocytes, lymphocytes, endothelial cells, natural killer cells, and platelets (p.216). The body views the medication as an intruder and attacks the same way it would attack a bacteria or virus.
Strep throat can occur in all genders and ages. However, it does not occur as often in adults (under 65), especially if they are not immune-compromised or work with children closely. If the patient had coughing, runny nose, I would not necessarily think it was strep as those are not regular symptoms. There is not much that would change my response unless the child was completed isolated from others, which one could assume a 16-year-old male would not be. I believe the reaction to provide the antibiotic was appropriate, as they could not predict the allergic reaction. The symptoms appeared to
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