Cases of Anaphylaxis and a Recap of ACAAI 2013 Meeting

Ken Lieu
Zainab Bukola Abdurrahman
Shudeshna Nag
Michelle Halbrich
Rhoda Kagan
Audrey Segal
Elana Lavine

November 19th, 2013 Cases of Anaphylaxis and a Recap of ACAAI 2013 Meeting

It was an intellectually stimulating night where eight physicians put their minds together to solve the mysteries of difficult patient cases.

Ken Lieu case #1
67 year old female. ? anaphylaxis in Mar 2012.

Began with palpitations, hives, angioedema of face, tongue, and chest tightness.

Went to ER, had HTN on presentation. Treated with EPI.
6 hours after recovered.

April 2012. Similar symptoms. Self treated with Benadryl. This time no angioedema and no respiratory symptoms.

No ARC, ? asthma

Demerol drug allergy. ? Lipitor allergy

Norvasc, atacand, zopiclone

tryptase, look for other food triggers, total IgE, seasonal?
5HIAA, catecholine, metanephrines, vma, serotonin

grossly elevated serotonin found. Patient sent to heme by Dr. Liew.

Dr. J Lee suggested referral to GI and ruling out of carcinoid syndrome.

Rhoda Kagan case #1
10 year old male
4 episodes of reactions

Poached pears, nut megs, lamb, brandy. Flushing

French fries, pita pit erythema, SOB.

? McDonald’s -> had a reaction

spices ->

No issues with nuts.

? oil
? sesame ? borderline ? latex ?tartrazine
fully worked up for idiopathic anaphylaxis and no abnormal results.

Dr. E Lavine suggested possibly sending to Dr. Sicherer in US, will do a test to >150 food tests. IZAC chip.

No consensus on diagnosis. Possibly sesame oil or tartrazine or carmine suggested by Dr. J Lee. Dr. Z Abdurrahman suggested possible spices. Dr. E Lavine mentioned that not many ketchups have tartrazine in ingredients.

Other possibilities include pure exercise induced anaphylaxis.

Elanna Lavine
Shared a case where dry powder bug spray has corn starch.

Zainab Abdurrahman
Severe asthma case. 8 year old male. On prednisone several times a day.

Pre and post bronchodilator > 40%. On zenhale, now improved.

? Consideration of biologic agents in this age group? Patient referred to Hamilton’s firestone clinic.

Audrey Segal
Minute maid orange juice. Shower anaphylaxis with urticarial, syncope, and angioedema.

Nausea, diarrhea. Swelling in joints. Decreased ROM in EOM by ophthalmology.

Skin prick test positive to mango.

Question was, what was the cause of the decreased ROM and abnormal EOM? Presyncope? Decreased perfusion? Unclear.

Elana Lavine
Asked the question: When do tree nut allergies develop?

Interesting theoretical discussion about this.

Immunocap to oval mucoid vs immunocap to egg white was also discussed.

Immunocap not predictive of oral challenge.

Component testing for prognostication emphasized for food allergies.


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