IDIOPATHIC ANAPHYLAXIS: A DIAGNOSTIC CHALLENGE

Abstract

<h3>Introduction</h3> Anaphylaxis is the most severe systemic hypersensitivity reaction which is potentially fatal. Its true prevalence is underestimated due to the variabilty of clinical presentation and different definitions in various guidelines. Details of the episode and risk factors are often not available from medical record. Serum Tryptase is rarely ordered at the time of initial presentation. <h3>Case Description</h3> 43 year-old female healthcare worker presented with genralized hives with pruritus, palpiations and racing heart, dizziness, shortness of breath on her way home from work in the evening. She had two episodes of diarrhea and somehow managed to climb 20 steps to her apartment where she collapsed soon after. She self-medicated with Benadryl and did not seek medical help. she had two further episodes 6 weeks and 3 months later. There was no hsitory food ingestion in the past 8 hours. She did not drink alcohol or use NSAIDS. No history of Insect sting. She had no history of atopy, food or drug allergy. None of these episodes were related to menstruation. She was on Amlodipine for Hypertension but no other medication and was otherwise in good health. Baseline Tryptase, 24 hour urinary 5-HIAA, N-methylhistamine, Metanephrines were normal. <h3>Discussion</h3> Idiopathic Anaphylaxis was diagnosed, and self-injectable Epinephrine was prescribed. Patient was educated about the serious nature of her condition, the use of Epinephrine and advised to seek medical help in an emergency. A note was givento patient to present ER Physician, to get Tryptase levels should another episode occur.