Drug Allergy Peer Feedback – Allison Ashman

Beta-lactam, present in many antibiotic medications, is the antigen that triggered Emily’s immune response. Her first exposure to the beta-lactam antigen was when she received IV ampicillin for her mouth lesions. Antigen-presenting cells (APCs) detected the foreign beta-lactam and engulfed it. APCs processed the information in the beta-lactam cell and presented it to T helper cells. The T helper cells signal B cells to produce IgE antibodies for the beta-lactam antigen. These IgE antibodies, either bind to mast cells and basophils, or remain free-floating, and they store information about the antigen to prepare for future exposures. Emily became sensitized during this process although she had no symptoms. 

Emily’s second exposure occurred when she took amoxicillin antibiotics during her first procedure.  APCs again detected the antigen, engulfed it, and presented it to her T cells. T cells recognized the antigen and signalled B cells to produce more IgE antibodies. Emily’s immune system became resensitized to beta-lactam antigens, and her immune system was fully activated for an immediate reaction if exposed to the antigen again. 

Three weeks later, during her second procedure, Emily received amoxicillin again. Her immune system, including mast cells, basophils and free-floating IgE antibodies, was now highly sensitized and initiated a strong reaction. APCs detected the beta-lactam antigen and alerted the T cells. T cells signalled for B cells to produce more IgE antibodies, which bound to antigen receptor sites, amplifying the response. The beta-lactam antigen binds to IgE antibodies on mast cells and basophils, causing other receptor sites to move closer to the antigen, and triggering mast cell degranulation. Mast cells release histamine, cytokines, and prostaglandins, causing vasodilation and leakage of fluid and plasma proteins from the blood vessels. Emily began to experience symptoms of a reaction, starting with an itchy foot, and then 30 minutes later, she developed angioedema that affected her ability to swallow, rapid respirations, and a rash on her body. The medical team realized that she was experiencing a reaction,  and gave her 25 mg of diphenhydramine hydrochloride, to treat the swelling and rash. Post-reaction care included blood pressure monitoring and medications to lower heart rate. Intradermal IgE testing later confirmed Emily’s allergic reaction to the beta-lactam in the antibiotics. Emily was advised to avoid amoxicillin and ampicillin antibiotics in the future. 

The content included in the video was very well explained and considered most aspects of the condition. If time allowed, some topics could have been included, or explained in further detail, to remove any gaps in knowledge. In the video, it was mentioned that Emily should not take ampicillin and amoxicillin, and should receive other penicillin medications instead. One gap that could be addressed is explaining which penicillin antibiotics would cause this same immune reaction, and which medications would be safe for her to take without the risk of reacting. This would be a beneficial topic to further educate viewers on because it would increase awareness and education about medication safety for people who have drug allergies and for healthcare workers caring for patients who may have allergies. 

One question I had while watching the video, was whether the reaction that Emily experienced was an anaphylactic reaction because it wasn’t stated specifically in the video. The video stated that drug reactions can progress to anaphylaxis, but it didn’t specify if what Emily experienced was anaphylaxis, or not. I think clarifying the type of reaction that Emily experienced, would help viewers to better understand the severity of the symptoms that Emily experienced. If she did not experience anaphylaxis, it could be beneficial for learners to observe how a more severe case would present, and how treatment and post-reaction care may be different. If the video could be made longer, an additional topic that could be included is the possibility of a biphasic reaction after an initial allergic reaction, and whether this is a risk for Emily in the 72 hours after her initial reaction. 

The true crime analogy was an excellent teaching strategy because it made the content engaging and exciting for viewers. I loved the visual components because they enhanced the content delivery by effectively illustrating the pathophysiology and the key case study details. This approach supported my learning as a viewer because it allowed me to clearly and effectively comprehend the process that Emily experienced and why it occurred. The crime analogy is a beneficial strategy for learners to remember key concepts of the video because it connects the content to something memorable. For example, associating “Cillin the Villain” with the symptoms of a drug reaction could allow healthcare providers to remember what signs to look for if they suspect their patient is having a drug reaction. Additionally, introducing the key players in Emily’s allergic reaction as characters in the story, enhanced my learning and comprehension by clarifying the role that each player had within the complex process of responding to a foreign antigen in the body. 

The format of the video was also beneficial because initially introducing the conditions and the progression of Emily’s case before discussing the details of the pathophysiology, helped the viewer follow the case and anticipate the next stages of her care. The case study was presented in a way that allowed the viewer to understand the context of Emily’s situation and to observe how with each exposure to the antigen, her body became increasingly prepared to react. The progression of the case study allowed me to understand why her immune system eventually acted so strongly against the antigen.

Overall, the combination of the crime analogy, the visual elements, and the presentation and format of the case study made the material engaging, memorable, and easy to comprehend, which positively supported my learning. 

One small change that I would recommend is slowing down the video pace and voiceover a slight bit, and adding more pronounced pauses between sentences. While I understand that there are many components of this condition to explain within the time limits of this assignment, I believe implementing this minor change would enhance the content delivery. This would also allow viewers to make meaningful connections between the condition’s pathophysiology and what Emily is experiencing. Providing an opportunity for the viewer to anticipate the next steps in her care as the case study unfolds, would allow them to engage on a deeper level and promote an effective learning experience.  

If video length was not a factor, the only other change to consider would be including more details about how some of Emily’s symptoms developed, such as the itchiness and rash. As a viewer, I would also be interested to learn more about what her post-reaction care included, and how the diphenhydramine hydrochloride treatment she received worked to decrease her symptoms and stop her reaction from progressing. It would also be beneficial to explain the intradermal testing of Emily’s IgE levels, and how that test confirms that she had an allergic reaction to the beta-lactam antigen. As a viewer with some previous knowledge on this topic, I was able to understand how many of the symptoms developed, but a viewer who was learning about this for the first time, could have some questions regarding why Emily experienced some of these symptoms and tests. 

Overall, this video was a very creative and engaging way to present the content, but it was still educational and provided thorough explanations about the condition and all the processes that were occurring in Emily’s body. 

One example of how I plan to integrate the knowledge I have gained from this video into my practice is that in the future when I am giving a new patient medications, I will ask if they have ever taken that medication before. I want to be aware if there is a risk of them reacting to the drug, so I can monitor them carefully for symptoms of an allergy. This is a vital education topic for nurses because they often give patients medications they have never previously taken. There is a risk they could become sensitized to a specific medication the first few times they take it. If they are then exposed again, they could develop a severe drug reaction, such as the one Emily experienced. Recognizing the symptoms of a reaction is essential for healthcare workers, so patients can be treated immediately and the cause can be identified. “Cillin the Villain” is a memorable character, and I will recall him in my future practice if I have a patient, who is experiencing any of these symptoms, such as hives, itchiness, angioedema, or hypotension, and I will explore the possibility of them experiencing a drug reaction. 

I liked how the crime analogy made the pathophysiology processes more simple to follow. In the future, I will use this comparison for patients with drug allergies, to explain what they are experiencing in a way they can understand and relate to. Educating patients on conditions they are experiencing in ways they can comprehend is extremely important because it increases their health literacy and awareness of their health. 

After reflection, I also considered how Emily’s ability to communicate her symptoms, was a beneficial factor in the fast recognition and treatment of her reaction. If she experienced this when she was younger, she may not have been able to communicate her initial symptom of an itchy foot, and it could have progressed into a more severe reaction before it was caught by the health care team. In my future practice, I will consider how when caring for patients who cannot communicate certain symptoms, I need to be vigilant and pay attention to small details that I can assess, such as a rash, that could be signs of something life-threatening.