Zainab Bukola Abdurrahman
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
No issues with nuts.
? 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.
Shared a case where dry powder bug spray has corn starch.
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.
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.
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.