Critical Analysis Of A Case Study Involving Allergic Reactions In Rural Clinical Practice

Prevalence of Allergies in Rural Areas

Allergic disorders such as hay fever, anaphylaxis, and asthma are now affected grossly 25% of the individual in advanced countries. However, the prevalence of the allergic reaction, especially within children or teenagers is higher in rural areas compared to those who lived in a developing area of countries (Mackey et al., 2016). The term allergy defined as the abnormal; adaptive immune responses that either caused by allergen-specific IgE or caused by do not involve. Although the increased occurrence of allergy observed in developing countries, .

Epidemiological studies conducted so far stated that the frequency of developing allergies from food, pollen or any other sources also prevail in rural areas and it is increasing gradually due to lack of awareness and improved health care sectors in rural areas (Itoh et al., 2015). Moreover, management of the allergic patient in the population is becoming more difficult because of increased prevalence and complexes. Although general practitioners are expected to play the crucial role in managing the allergic reactions, they are often ill-equipped for managing the allergic reaction.

According to Tsukamoto, Yamamoto and Makino (2014), when allergic reactions become serious, the only effective drug for treating the allergy is epinephrine. Injection of epinephrine within the minute can save the lives of children or teenager (Itoh et al., 2015). However, there are certain barriers to using epinephrine in managing patients who are coming from remote or social areas. Therefore, this paper will illustrate a case study of allergic reaction which is treated by  Primary Clinical Care Manual”.

Discussion:

In primary care setting, women of 17 years with severe allergic reaction came in the emergency room due to consumption of peanut. On arrival, emergency personal noted diffuse and severe urticarious on patient’s arm, leg, face and severely observed around the mouth and eyes. During taking histories from the parents of the patient, they stated that she was having lunch with family members when she was experiencing trouble in breathing and wheezing within few minutes. Her parents stated that she was also exhibited the signs and symptoms confusion and slurred speech.

During transportation to the hospital, she was experiencing server-breathing problem, immediately become unconscious and when she arrived at the hospital, pulse rate -100 beats per minute and upper airway obstacles were observed. Since it was not known allergy, she was unaware of the reactions, which in turn threaten her life. After diagnosis, the health professional with collaboration with dermatologist and cardiologists suggested that epinephrine therapy but due to cultural beliefs, her parents refuse to adhere to the treatment procedure. However, lastly, it was injected into the patient for faster recovery.

In recent years, it is clear that the burden of the disease associated with allergic disorders reflects the long-term consequences of chronic allergic inflammations at the sites of repeated exposure of allergen.  A study Machado-Alba et al. (2017), suggested that food allergy by consuming peanut is one if the common cause of anaphylaxis. Anaphylaxis encompasses a Variety of the signs and symptoms where the diagnosis is largely based on history and physical findings. According to Conte et al. (2014), the common form developed by food allergen which developed IgE mediated reaction to the food such as peanut.

Difficulties in Managing Allergic Reactions in Rural Clinical Practice

it accompanied by inflammations and induced by cellular components such as T cells and eosinophils. Patients with IgE associated with the food allergy can be based on on the detection of food allergen-specific IgE in the serum and body fluids. According to Lee and sun (2017), every three minutes a food allergy reactions sent someone in the emergency room. Each year approximately 40% of the individuals are affected by consuming foods such as prawn, peanuts or due to inhalation of pollen. In the year between 1990 and mid-2000, the hospitalization rate due to allergic reaction and anaphylaxis was tripled compared to the prevalence observed in other years (Xu & Dou, 2015).

Once serious allergic reactions are starts, epinephrine is proved to be most effective therapy for managing the reactions. Nurses have a major role in the routine care of patients with an allergic reaction. In the above case study, nurses injected the epinephrine to the patient since its actions on the alpha androgenic receptors, epinephrine lessen the vasodilatation and increased vascular permeability, which occurred during food allergy (Cho  & Kwon, 2018).

Rural residents often experienced barriers to the primary health care that limited their ability to seek professional support. Poor socio-economic status of the individual in the rural area plays the huge role in current primary care nurse’s practices since a majority of the individuals do not seek professionals help in allergic reactions in the rural area which in turn increase the global burden of the disease (Health.qld.gov.au. , 2018). The reason behind it is majority of the individualism in rural area believed in traditional healers and thereby, they do not seek help from the primary care setting of local area as observed in this case study (Weber et al., 2018).

In the cases study, the parents of the patients were apprehensive about epinephrine therapy and at first, they refused to seek help. Even if they seek help from the local primary care practitioners, due to certain cultural beliefs and mindset, they refuse to agree for treatment procedures involving epinephrine, which in turn worsen the allergy-related disorders in rural areas (Weber et al., 2018). Other factors such as unpredictable linguistic, educational disparities, lack of availability of resources to support personnel, lack of facilities impacted the nurse’ practices of administrating epinephrine in the primary care setting (Cho  & Kwon, 2018).

A study by McWilliam et al. (2018),  stated that although epinephrine is the drug of choice in the majority of the primary care setting, restricted services and vary in equipment for the practice, impacted the primary care nurses practices. The Rural Health Support, Education and Training (RHSET) report also suggested that practice in the rural area is not standardized; lack of clinical governance, lack of accurate protocols, profession role statement and lack of multidisciplinary team also affected the practices (Machado-Alba et al., 2017).

Therefore, it influenced the consumers as well as practitioners. However, although there are certain barriers of the practices, the primary care nursing practices in the rural area is beneficial for the consumers who experienced server allergic reaction due to lack of awareness or environment full of allergen. During the treatment procedure in the primary care setting, the practice helps rural people to acquire basic knowledge about hypersensitivity reactions and risk factors of developing hypersensitivity reactions (McWilliam et al., 2018). Therefore, they will be aware of consuming any food that might contribute to hypersensitivity reactions. Furthermore, practitioners also benefited from the practice in the rural area since it will improve the economic performance of the health care sectors, reduce the burden of the disease and mortality rate in the rural areas.

Epinephrine as an Effective Therapy for Serious Allergic Reactions

A study by McWilliam et al. (2018), also suggested that since the economic status of the majority of the individuals has the lower socioeconomic status they refuse to seek professionals helps and administration of epinephrine. Epinephrine twin pack in Australia costs $38, which remain stable from the 1990s (Machado-Alba et al., 2017). However, due to socio-demographic positions, individual in rural areas cannot afford to pay for the treatment procedures.

There is a power imbalance also observed between nurses and patient, patient and doctor, nurses and doctor. Power struggler mostly in the relationship between nurses and patient along with nurses and doctors are patient and nurse’s respectively (Tobiano et al., 2016). The reason behind such a relationship is that patients lack accurate knowledge about the area of concern and nurses do not have sound knowledge about big medical terms (Greenhalgh et al., 2015).

  Apart from the primary care setting, cardiologist and dermatologists are involved in this case since the patient was unconscious and her upper airway tract was blocked, any administration of the medication should be done after consultation with cardiologists and dermatologists. As observed in this case study, the patient was experiencing wheezing due to the allergic reaction of peanut, the nurses and health professionals consulted a cardiologist for the heartbeat of the patient, before administrating epinephrine (Tobiano et al., 2016) . The dermatologist evaluated her symptoms nod allergies spreader in the face and then agreed to give epinephrine for immediate management of the patient.

According to McWilliam et al. (2018), a potential alternative of epinephrine is antihistamines and corticosteroids for management of anaphylaxis. The primary mechanisms of antihistamines are that it believed to act as the competitive antagonism of histamine binding to cellular receptors especially receptor H1 which are situated in the nerve endings, smooth muscles, and glandular cells. Histamine receptors are consisting of H1 or H2 and the antihistamines act upon any of the receptors to reduce the effect of released histamines from the immune cells.

According to McWilliam et al. (2018), the rationales for using antihistamines are they are second-line drugs that manage allergy after immediate stage of management. According to Machado-Alba et al. (2017), they are not life-saving medicines and therefore it does not use for initial treatment but it is effective if epinephrine is not present. No evidence supported the use of H1 antihistamines in anaphylaxis, which relieves itching, flushing, urticarious. A study also suggested that it does not act on the obstacles airway or hypotension is caused by allergic reactions. Corticosteroids are also used for managing the allergic infections since it lessens the swelling, itching and redness (Tobiano et al., 2016).

Therefore, further research required in the domain of the hypersensitivity reactions where antihistamines manage the severe allergic reactions by primary care practitioners and training required for accurate administrations of the antihistamines. Although the cost of epinephrine’s and antihistamines are similar in some cases where the patient has blocked airway ad high heart rate, antihistamines are effective (Health.qld.gov.au., 2018). As observed in this case study, the patient has an increased heart rate due to allergic reactions; antihistamines can be administrated instead of the epinephrine for avoiding increased heart rate. Moreover, these drugs also have mild side effects such as confusions, hypotension.

Barriers to Primary Care Nursing Practices in Rural Settings

H1 antihistamines are more secured to used for the patients with allergic reactions rather than H2 histamines(Cho  & Kwon, 2018) .Further research also required for administration of H2 histamines in primary care setting for managing allergic reactions, proper knowledge of the acquired. Medical practitioners, nurses or other healthcare staffs can evaluate the evaluation of such drug administrations.

The evaluation procedure is thorough monitoring of the patient time to time in order to notice the improvement of patients such as normal heartbeat, clear heartbeat, and normal skin without any allergic symptoms (Kaminaka et al., 2014). Informed consent should be obtained from the patient for the treatment procedures. Another evaluation can be done by observing patients or communicating with them about their feels after administration of drugs.

Since the alternative therapies such as antihistamines and corticosteroids are not effective as administration of epinephrine, further evaluation techniques need massive analysis for obtaining the efficiency of the antihistamines. Moreover, a considerate number of individuals are unaware of the effectiveness of antihistamines and no evidence was found that support the effectiveness of antihistamines over epinephrine’s for practicing in the primary care setting (Conte et al., 2014). Therefore, the study requires in that domain for alternative therapies.  Moreover, the use of any device or nursing tools can be an effective way of evaluating the effectiveness of potential alternative therapies such as antihistamines.

Conclusion:

Thus, it can be concluded that the global burden of the disease associated with allergic disorders reflects the long-term consequences of chronic allergic inflammations at the sites of repeated exposure of allergen. The case study represents the severe allergic reaction of 17 years old women who consumed peanut in lunch.  Emergency personal noted the diffuse and severe urticarious on patient’s arm, leg, face and severely observed around the mouth and eyes. SHE exhibited the signs and symptoms confusion and slurred speech.

After diagnosis, primary care nurses administrated her with epinephrine. Although it is an effective treatment, the majority of the individuals from rural area refused to seek help due to their cultural beliefs, which increase the burden. Alternative therapies such as antihistamines can be used for the patient with an allergic reaction but no evidence found that support the effectively more than epinephrine. Therefore, further research and evaluation required in the domain for accurate nursing interventions.

References:

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Conte, B., Zoric, L., Bonada, G., Debaene, B., & Ripart, J. (2014). Reversal of a rocuronium-induced grade IV anaphylaxis via early injection of a large dose of sugammadex. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 61(6), 558-562.

Greenhalgh, T., Snow, R., Ryan, S., Rees, S., & Salisbury, H. (2015). Six ‘biases’ against patients and carers in evidence-based medicine. BMC medicine, 13(1), 200.

Health.qld.gov.au. (2018). Primary clinical care manual. Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0027/426069/pccm-part1-manual.pdf

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