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Allergy

Allergy

A 4-year-old, previously healthy girl presented to a tertiary care children’s hospital emergency department (ED) with large, tense bullae involving up to 40% of her body surface area. The patient’s parents described a 12-day history of itchy, papulovesicular lesions that had progressed into large blisters.

As the calendar advances to the fall months, we are reminded everywhere that it’s time for the annual influenza vaccination. In August 2011, the Advisory Committee on Immunization Practices (ACIP) updated its vaccination recommendations to include new guidelines for children ages 6 months through 8 years, and for persons with egg allergy.

Like many physicians, I find it difficult to care for a
patient with a terminal disease—a discomfort
heightened when the patient is an ebullient, beautiful
child.

My 18-month-old son has had a diaper rash, with no other symptoms, within a few days of eating a poached egg on 3 separate occasions.

This 9–month–old boy was initially evaluated at age 6 weeks for an extensive eczematous rash on the head and antecubital and diaper areas and blood and mucus in the stool with each diaper change over a 2– to 3–week period. The symptoms were attributed to milk allergy, and the infant’s formula was changed. At 8 weeks of age, a petechial rash developed on the boy’s trunk and legs. His symptoms persisted despite multiple formula changes, and he was referred to the emergency department.

A 7-month-old boy with a history of severe atopic dermatitis and asthma was brought for evaluation of a generalized rash, fever, and irritability of 2 days’ duration. He had no respiratory symptoms. His medical history was significant for anorexia, without vomiting or diarrhea. He had a strong family history of allergy.

Match the photographs of the rashes with the correct diagnosis.

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