Acute food-induced anaphylaxis in an elderly male with comorbidities

Kalaiselvi1*, Subathra Devi. M2, Maha Lakshmi3

1Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

Anaphylaxis is a rapid-onset, potentially fatal systemic hypersensitivity reaction that requires immediate recognition and treatment. Food-induced anaphylaxis remains a common trigger, particularly in susceptible individuals. We report a case of acute anaphylaxis in a 67-year-old male with type 2 diabetes mellitus and coronary artery disease following ingestion of mutton gravy. Prompt administration of intramuscular adrenaline and supportive management resulted in clinical improvement. This case highlights the importance of early diagnosis and adherence to standard anaphylaxis treatment protocols in elderly patients with comorbid conditions.

Keywords: Anaphylaxis; Food allergy; Adrenaline; Elderly patient; Emergency medicine

Introduction

Anaphylaxis is a severe, life-threatening allergic reaction characterized by rapid onset and involvement of multiple organ systems, including the respiratory and cardiovascular systems. Food allergens are among the most common causes of anaphylaxis. Early administration of intramuscular adrenaline remains the cornerstone of management. Elderly patients with underlying comorbidities pose additional challenges due to increased risk of complications and atypical presentations. This report describes a case of food-induced anaphylaxis in an elderly male successfully managed in the emergency department.

Case Presentation

A 67-year-old male presented to the Emergency Department around 7:00 p.m. on 02.01.2026 with complaints of tongue swelling, drooling of saliva, difficulty in swallowing, and minimal breathing difficulty. There was a history of consuming mutton gravy at approximately 1:30 p.m. on the same day. On arrival, the patient was conscious and vitals were stable. In view of clinical features suggestive of angioedema, an injection of Adrenaline infusion was started immediately. Relevant investigations were carried out. Following the infusion, the patient showed significant improvement. The Adrenaline infusion was discontinued after 6 hours, and the patient was kept under observation in the critical care unit. As the symptoms resolved and the patient remained hemodynamically stable, the patient was discharged in stable condition.

Relevant Clinical Findings

Social History: He does not have any social history of cigarette smoking and alcohol addiction.

Allergies: Not a known medicine

Past Medical History: Known case of DM, CAD on regular treatment.

Past Surgical history: Wound debridement + sequestrectomy + Right 2nd toe amputation done on 07.09.2025

Physical Examinations

On examination at admission, the patient was conscious and oriented.

Blood pressure120/70 mmHg
Heart rate76 Beats/min
Respiratory rate20 Breaths/min
Oxygen saturation98% on room air
Temperature98.7°F
GCSE4 V5 M6
Random blood sugar (GRBS)290 mg/dL

Relevant Investigation on 03/01/2026

TimelineParameterResult
00:11HrsBE(B)-6.3 mm Hg
K +2.9 mmol/L
Glucose353 mg/dL
PCO230 mm Hg
pH Blood7.38 NA
Chloride Blood109 mEq/L
02Sat22:43:41
HCO3(c)17.7 mmol/L
Haematocrit09:07:12
TCO218.6 mmol/L
NA+140 mmol/L
CA++(7.4)1.05 mmol/L
PO2101 mm Hg
Lac4.6 mmol/L
00:57 HrsCalcium Free Ionized1.20 mg/dL
Sodium.142 mmol/L
Chloride103 mmol/L
Creatinine0.7 mg/dL
Urea Serum19.2 mg/dL
Blood Glucose Random (RBS)259 mg/dL
Potassium2.9 mmol/L
AnGap20 mEq/L
Packed Cell Volume (PCV)09:50:24
Haemoglobin13.9 g/dl
07:06 HrsAlbumin, Serum3.85 g/dl
A/G Ratio1.12 .
Alanine Aminotransferase (ALT/SGPT)27 U/L
Globulin3.45 g/dl
Total Protein7.30 g/dl
Total Bilirubin0.31 mg/dL
Gamma - Glutamyl Transferase (GGT)26 U/L
Direct Bilirubin0.13 mg/dL
Indirect Bilirubin0.18 mg/dL
Alkaline Phosphatase106 U/L
Aspartate Aminotransferase (AST/SGOT)28.3 U/L
Absolute Lymphocyte Count (ALC)1360 cells/µl
(MCH) Mean Corpuscular Haemoglobin27.9 pg/cell
Mean Corpuscular Volume (MCV)21:36:00
Total WBC Count19120 Cells/Cumm
Platelet Count311000 cells/µl
Total RBC Count4.56 ML/10^9
Test (PT)11.8 Seconds
Monocyte00:30:14
Control (PT)11.7 Seconds
Absolute Neutrophil Count (ANC)17300 cells/µl
Absolute Monocyte Count (AMC)410 cells/µl
Basophil00:02:53
Mean Platelet Volume (MPV)9.3 NA
Haemoglobin12.7 g/dl
Mean Corpuscular Haemoglobin Concentration 31.7 g/dl
Lymphocyte01:42:14
Packed Cell Volume (PCV)09:37:26
Absolute Eosinophil Count (AEC)10 cells/µl
Absolute Basophil Count (ABC)40 cells/µl
Eosinophil00:01:26
INR1.01.
RDW - CV03:18:43
Neutrophil90.50%

Diagnosis: Anaphylactic shock

Management

Further treatment comprised:

  • Nil per oral (NPO)
  • Intravenous fluids (Ringer’s lactate/Normal saline) at 100 ml/hour
  • Intravenous Hydrocortisone 100 mg twice daily
  • Intravenous Dexamethasone 8 mg three times daily
  • Nebulization with Duolin and Budesonide twice daily
  • Intravenous Pantoprazole 40 mg twice daily

Outcome

The patient was closely monitored for airway compromise, hemodynamic stability, and glycaemic control. There was gradual resolution of tongue swelling and improvement in swallowing and respiratory symptoms. No further episodes of desaturation or hemodynamic instability were observed.

Nursing Management

Airway Assessment & Maintenance

  • Assess airway patency immediately.
  • Monitor for stridor, increased swelling, voice changes, and respiratory distress.
  • Keep emergency airway equipment (Ambu bag, laryngoscope, intubation tray) ready.
  • Position patient in Semi-Fowler’s position to ease breathing.

Breathing Monitoring

  • Monitor respiratory rate, SpO₂, and work of breathing.
  • Administer oxygen therapy as prescribed.
  • Observe for worsening breathing difficulty.

Circulation Monitoring

  • Monitor vital signs (BP, pulse, temperature) frequently.
  • Watch for signs of hypotension or anaphylaxis.
  • Maintain IV access for emergency medications.

Medication Administration

  • Administer Inj. Adrenaline infusion as prescribed.
  • Administer antihistamines, corticosteroids, and other supportive medications as ordered.
  • Monitor for drug side effects (tachycardia, arrhythmia).

Monitoring Response to Treatment

  • Assess reduction in tongue swelling.
  • Monitor improvement in swallowing and breathing.
  • Document time of medication administration and patient response.

Patient Safety & Observation

  • Kept the patient under close observation in critical care.
  • Watch for rebound symptoms after stopping Adrenaline.
  • Ensure emergency drugs are readily available.

Discharge medications

Drug NameStrength
Tab. Ranitidine150 Mg
Tab. Avil25 Mg
  • Advise avoidance of suspected allergen (mutton gravy/food trigger).
  • Educate about early signs of allergic reaction.
  • Instruct to seek immediate medical help if symptoms recur.
  • Encourage follow-up with physician/allergist if required.

Discussion

Food-induced anaphylaxis is a medical emergency that necessitates prompt diagnosis and immediate treatment. Adrenaline is the first-line therapy and should not be delayed. Elderly patients with diabetes and coronary artery disease require careful monitoring due to increased susceptibility to adverse outcomes. This case emphasizes adherence to established anaphylaxis management protocols and vigilant observation in high-risk populations

Conclusion

This case highlights an acute episode of angioedema likely triggered by food intake, presenting with tongue swelling, drooling, and mild breathing difficulty. Early recognition of symptoms and prompt initiation of Adrenaline infusion played a crucial role in preventing airway compromise and further complications. Continuous monitoring and timely medical intervention resulted in significant clinical improvement. The patient remained hemodynamically stable during observation and was discharged in stable condition. Proper patient education regarding avoidance of potential allergens and early identification of warning signs is essential to prevent recurrence and ensure patient safety.

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