Age: 22.0
Sex: F
Vaccine: ANTH, TYP
Symptoms: Immediate post-injection reaction, Pharyngeal swelling, Throat tightness, Vomiting
Clinical narrative: pt c/o vomiting due to allergic reaction from vaccines she received an hour ag. pt states that throat feels swollen. speech clear. resp even and non labored. pt states that she has epipen with her. lungs cta. no rash noted. mild swelling noted to throat.  22-year-old female with pertinent history of anaphylaxis to NSAIDs requiring hospitalization approximately 2 years ago presents to the emergency department with signs and symptoms consistent with anaphylaxis secondary to multiple vaccinations earlier today.  She is unsure what vaccinations she received.  In her administered medications section of her chart patient has she was given the anthrax vaccine (BioThrax) and the inactivated typhoid vaccine (Typhim VI).  She was present at the soldier readiness center and was administered vaccinations given her units upcoming deployment (though she is not deployable due to a profile according to the patient).  She had an immediate reaction with emesis following receiving the vaccines.  This was followed by headache and the sensation of throat tightening.  She was administered Benadryl at the soldier readiness center which did not relieve her symptoms.  She subsequently presented to the emergency department due to concern that she was having an anaphylactic reaction given her symptoms being similar to her anaphylactic reaction to NSAIDs in the past.  Upon presentation to the emergency department she had continued throat tightness with associated shortness of breath and difficulty speaking.  She denied any skin changes throughout this episode.  Her vitals at that time were BP 120/76, HR 96, RR 16, SPO2 100% on room air.  She was administered Benadryl 50 mg p.o., epinephrine 0.3 mg IM, and methylprednisolone 125 mg IV.  She also received 1 L of normal saline.  Following administration of medications in the emergency department her symptoms improved though she has continued sensation of throat tightness without shortness of breath.  Beta-hCG was negative.  No other laboratory or imaging studies were performed  1. Anaphylaxis  22-year-old female with pertinent history of anaphylaxis to NSAIDs requiring hospitalization approximately 2 years ago presents to the emergency department with signs and symptoms consistent with anaphylaxis secondary to vaccination with inactivated typhoid vaccine and anthrax vaccines.  Due to the close interval of the administered vaccines it is unclear which caused her anaphylactic reaction or if it was both.  Patient is currently mildly symptomatic with persisting sensation of throat tightness that has improved following administration of methylprednisolone, Benadryl, and epinephrine.  I will admit this patient for observation overnight to confirm that following the effect of the methylprednisolone wearing off she does not have rebound anaphylaxis.  Her disposition will be the stepdown unit to assure she has close monitoring.  In the event that she has repeat anaphylaxis she should be given epinephrine 0.3 mg IM x1 and considered for repeat adjunctive treatment with methylprednisolone and Benadryl. ?Admit for observation with plans to discharge in morning if symptoms have resolved ?If rebound anaphylaxis occurs repeat treatment with epinephrine, methylprednisolone, and Benadryl  2. Allergic reaction to drug  3. Angioedema