DELAYED, PERSISTENT ANAPHYLAXIS AFTER AN ALLERGY INJECTION

Abstract

<h3>Introduction</h3> Delayed or biphasic anaphylactic reactions are rare. We report a delayed onset, prolonged anaphylactic reaction which occurred twelve hours after the first dose of allergen immunotherapy. <h3>Case Description</h3> 35 year-old male with allergic rhinoconjunctivitis and many positive serum aeroallergen tests initiated allergen immunotherapy for severe persistent symptoms despite treatment with Fluticasone, Cetirizine, and Azelastine. Twelve hours after his first allergy injection, he developed pruritus, took a diphenhydramine and went to sleep. When he awoke the next morning, his spouse noted that his face, back, and chest were erythematous and the pruritus continued. He had scattered urticaria as well. He developed wheezing 24 hours after the injection and then again approximately 72 hours later which he treated with an Albuterol MDI. He did not seek medical attention at any point, but took diphenhydramine which only helped temporarily. He notes that he just "ignored the symptoms." He had an Epi pen in his possession but did not use it. The itching and rash persisted for approximately ten days and the wheezing remitted within five. Allergy injections were not reinitiated. <h3>Discussion</h3> This is an example of late-onset anaphylaxis which lasted greater than a week, likely due to lack of appropriate medical treatment. It is important to educate our immunotherapy patients on the signs of anaphylaxis as well as the possibility that though rare, symptoms can be delayed. In addition, it is important to emphasize the need for prompt medical attention in such situations.