Age: 45.0
Sex: M
Vaccine: ANTH
Symptoms: Arthralgia, Chest discomfort, Dyspnoea, Face oedema, Headache
Clinical narrative: This healthy 45 year-old received his third Anthrax vaccination on 12 July 2004.  Approximately 3-4 weeks later he reports a sudden onset of facial swelling.  His medical records document he was riding his bicycle home from work approximately two hours after drinking a Bing cherry sports drink and eating some peanuts when he felt a tingling with associated swelling to his right upper lip that extended into the right cheek area ("like a cold sore").  He saw the doctor the next day and was given Benadryl with relief of the swelling.  He reports a history of oral numbness with honey dew melons but no problems eating peanuts or cherries. He denied any stings, bites, trauma to the face, new foods or clothing, respiratory distress, breathing difficulty, chest pain, nausea, vomiting, or itching.  He reports no past allergies, reactions, new foods, cloths, travel or shampoos, deodorants or detergents.   He continues to be evaluated since 13 September 2004 to present.  He documents he was "ok for three weeks following AVA #3 then problems began since return home."  He was placed on Benadryl prn, Claritin, Epipen, Flonase for his nose, r/o autoimmune disorder due to low c4, questionable relation to anthrax vaccination as there are case reports of angioedema and anthrax vaccinationquestionable serum sickness related, has knee joint pain."  A RAST showed positive to Kentucky blue grass, cats, peanuts and Bing cherry.  He showed a low complement C4 (16.3), normal ci esterase, cholesterol of 209, BUN/Creatinine of 22/1.3, and eosinophils high at 5.4, otherwise normal labs.  His last episode of facial swelling occurred 14 March 2005 after leaving MD's office.  As of March 16, 2005, he reports continued periodic facial (eyelids, lip, chin) swelling with no further groin (penial) swelling that occurs spontaneously in the afternoon or evenings/nights 3-5 times a month lasting for 8-12 hours with no known triggers.  He no longer eats peanuts or cherries and has no cats.  A single dose of Benadryl 50 mg PO will resolve the swelling with repeat doses periodically required in 2-3 days.  He used Claritin, Flonase and Singulair secondary to allergy response and nightly chest tightness (hard to breath in) from September to December 2004.  He has since stopped the Singulair with no reoccurrence of the chest tightness. He continues to use Flonase and Claritin.  Following a recent physical in 2005, his surgeon grounded him for using Claritin.   He also noticed the onset of headaches over the last six (6) months.  He describes the headaches as an intense pain (7-9/10) with inability to concentrate lasting 3-4 hours located to the sides of his head/temple region.  These headaches occur twice a month.  However, he has had four in past two weeks secondary to loss of a friend (attending a funeral).  A single dose of 800 mg Motrin or a couple of aspirin will relieve the headache.   He admitted to increasing joint pain to both knees and ankles over the last six months that will resolve with a Motrin or aspirin.  He attributes these discomforts to physical activity during the week.  He describes the pain as an ache deep in the joint.