C09999156 / invoice 10000

Reason: Allergic Reaction History:Presented for vomiting and hives which developed approximately 4 hours after a Cytopoint injection administered at 5 PM today. The owner observed a single episode of vomiting at the back door around 9:15 PM, followed by the appearance of hives. A patch of hair loss with associated hives was also noted on the neck. This is reported as the most severe reaction to date. There was no collapse.Hulk has been receiving Cytopoint injections every four weeks from December to March for the last three years. This is the third allergic reaction he has experienced. His regular veterinarian is Freestone Heights. Current meds: Cytopoint injection at 5 PM today.Pre-existing conditions: History of mild allergic reactions to Cytopoint.Access to toxins: nil Subjective:BARObjective:Temp: 37.8  MM: injected, moist CRT< 2 secs     HR: 148 beats/min   FP: strong femoral pulses synchronous with HR   RR: 28 breaths/minBCS:    5/9                Wgt:  12.1  kg CV:  NAD, no heart murmur or arrhythmia, normotensive at 111/96 (101)RESP:   NAD           GIT:  no laryngeal oedema notedU/G:  NADNeuro:  NADM/S:  NADInteg: urticaria and erythema noted around muzzle (significantly decreased with one dose of niramine SC), flanks and all four paws, lick discolouration on all four paws, no areas of swelling or stinger noted Ophth:  NADLNs: NADProblem List:- Suspected Type 1 hypersensitivity reaction to Cytopoint injection (mild-moderate)- Urticaria and erythema- Vomiting (single episode)- PruritusAssessment: Hulk presented for a suspected mild to moderate Type 1 hypersensitivity reaction following a Cytopoint injection administered approximately 4 hours prior. Clinical signs included a single episode of vomiting, urticaria, and erythema. Examination revealed no evidence of cardiovascular or respiratory compromise (e.g., laryngeal oedema, hypotension). The reaction is considered mild at this stage. Urticaria and erythema significantly improved following administration of an antihistamine.Treatment: 0.6 ml Niramine SC 	Plan: The plan is for discharge with a 3-day course of oral antihistamines (chlorpheniramine) and strict monitoring at home for any delayed or worsening signs. The owner has been advised to inform their regular veterinarian of this event and to consider pre-medication with antihistamines prior to any future Cytopoint injectionsClient Communication:The owner was counselled on the nature of allergic reactions in dogs, which primarily manifest with gastrointestinal and cutaneous signs rather than respiratory signs typical in humans. The grading of anaphylactic reactions was explained, and Hulk's reaction was classified as mild. The potential for more severe or delayed reactions was discussed, and the owner was advised to monitor closely for the next 72 hours. The purpose of the dispensed antihistamines is to decrease the severity of a potential reaction, not prevent it entirely. The plan to pre-medicate before future injections was discussed as a preventative measure. The owner was advised on signs that would warrant immediate re-presentation (e.g., airway swelling, collapse). Reassurance was provided that current cardiovascular status is stable.    Vital Signs