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The vast majority of skin problems that present in the community are minor in nature. Unfortunately, very occasionally, the development of seemingly innocuous symptoms such as a rash and/or itching can be the presenting symptoms of a life threatening condition—namely anaphylaxis or meningococcal septicaemia. While other clinical conditions can mimic both anaphylaxis and meningitis, especially in the early stages, there are usually clues in the presentation that help to minimise the delays in administering appropriate therapy. It is not possible in this article to cover all potential causes of a rash and/or itching. Rather, this chapter aims to focus on important conditions that require recognition, treatment, and possible referral in the acute prehospital setting. Box 1 lists the objectives of this article.
Box 1 Article objectives
With regard to the presentation of a rash and/or itching:
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To understand the basic physiology and pathology underlying allergic causes of rashes and itching
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To perform a primary survey of the patient and treat any immediately life threatening problems
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To identify any patients who have a normal primary survey but have an obvious need for hospital admission
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To perform a secondary survey incorporating other body systems that may be affected by a rash and/or itching
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To consider a list of differential diagnoses
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Discuss treatment based on the probable diagnosis(es)
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Discuss appropriate patient follow up
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Describe who can be safely considered for home treatment
BASIC PHYSIOLOGY AND PATHOLOGY UNDERLYING ALLERGIC CAUSES OF RASHES AND ITCHING
Allergic reactions are linked to the release of chemical mediators, which are released from mast cells in a process known as degranulation.1 This occurs when an allergen cross links with immunoglobulin E (IgE) bound to receptors on mast cells. These chemicals are either released immediately (immediate allergic reaction), or after a few hours (late phase response). This timing helps to guide appropriate treatment.
PRIMARY SURVEY
Assess for an ABC problem in patients …