POLLEN INDUCED ANAPYLAXIS THROUGH SKIN ABRASION

Abstract

<h3>Introduction</h3> Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast cell- and basophil-derived mediators into the circulation. We present an unusual case of anaphylaxis to pollen exposure through abraded skin secondary to a skateboard accident. <h3>Case Description</h3> A 19- year-old women with past medical history of mild allergic rhinitis treated with OTC antihistamines as needed had a skate board accident that led to large abrasion" road rash" on the right posterior thigh and buttocks. She notices the abrasion occurred on ground where there was a significant degree of pollen dust which contaminated her abrasion significantly. One hour later, she developed diffuse urticaria, dyspnea and wheezing. She went to emergency room and was treated with epinephrine intramuscular injection, methylprednisolone, diphenhydramine IV and albuterol. She was admitted overnight for observation with no biphasic reaction. No clear source for the anaphylaxis was immediately noted as there had been no new foods, medications, insect sting or history of exercise induced anaphylaxis. On subsequent evaluation she was found to have markedly elevated timothy grass pollen IgE (96.7 kU/L) known to be pollinating at the time. <h3>Discussion</h3> Grass pollens hypersensitivity is common allergic rhinitis trigger, however, anaphylaxis from exposure via a skin abrasion is not reported to the best of our knowledge. We would like to draw attention that grass pollen sensitization as a potential source of anaphylaxis following exposure to the blood stream via significant abraded skin.