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Idiopathic anaphylaxis and undiagnosed anorexia nervosa

2018; Elsevier BV; Volume: 122; Issue: 2 Linguagem: Inglês

10.1016/j.anai.2018.10.017

1534-4436

Marcus Shaker, Irene Yuan, Katie Kennedy, Peter Capucilli, Jonathan M. Spergel,

Food Allergy and Anaphylaxis Research

This report describes an association between anorexia nervosa and idiopathic anaphylaxis. Although eating disorders affect 0.6% of the population, 1 Hudson J.I. Hiripi E. Pope Jr, H.G. Kessler R.C. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007; 61: 348-358 Abstract Full Text Full Text PDF PubMed Scopus (3342) Google Scholar and idiopathic anaphylaxis occurs in approximately 1 in 10,000 individuals, 2 Patterson R. Hogan M.B. Yarnold P.R. Harris K.E. Idiopathic anaphylaxis: an attempt to estimate the incidence in the United States. Arch Intern Med. 1995; 155: 869-871 Crossref PubMed Scopus (52) Google Scholar an association between anorexia nervosa and mast cell dysfunction has not previously been described. Features of anorexia nervosa include restriction of eating and energy intake, intense fear of gaining weight, and distorted perception of body weight and shape. 1 Hudson J.I. Hiripi E. Pope Jr, H.G. Kessler R.C. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007; 61: 348-358 Abstract Full Text Full Text PDF PubMed Scopus (3342) Google Scholar We describe a 14-year-old girl with a history of well-controlled hypothyroidism who developed sudden lip and eyelid edema, abdominal pain, stool urgency, lethargy, diarrhea, vomiting, throat tightness, and presyncope. Her symptoms began 30 minutes after she finished eating vegetables from a Ruby Tuesday's salad bar in Philadelphia. On arrival to the emergency department after ambulance transport, she had a blood pressure of 110/60 mmHg, with bradycardia of 50 beats/minute and greater than 5 second capillary refill, along with cool distal extremities. Treatment included 0.3 mg intramuscular epinephrine × 8 and subsequent intravenous epinephrine infusion, intravenous fluid resuscitation, nebulized albuterol, intravenous corticosteroids, and diphenhydramine. Antecedent events included travel and a recent upper respiratory tract infection, for which ibuprofen had been used 7 hours before symptom onset. Foods consumed before the event were lettuce, spinach, pepper, onion, tomato, cilantro, cucumber, carrot, ranch dressing, pumpernickel croutons, parmesan cheese, onion, artichoke, oranges, grapes, ham, and pasta; however, the patient was previously and subsequently tolerant of each of these foods. Before dinner, the patient had used Zicam (Galphimia glauca 4×, Luffa operculata 4×, Sabadilla 4×) and ibuprofen, but subsequently tolerated Zicam, aspirin, and ibuprofen. Acute serum tryptase at the time of the event was 32.5 ng/mL (with convalescent tryptase after event measuring 3.2 ng/mL). Specific immunoglobulin E testing was negative to shrimp, crab, sesame, galactose-alpha-1,3-galactose, and latex, with negative skin testing 4 weeks later to shrimp, lobster, scallop, egg, milk, soy, wheat, peanut, almond, walnut, cashew, sesame, lettuce, onion, and latex. Her medical history was negative for symptomatic rhinitis, asthma, or food allergy, with skin prick testing positive only to Timothy grass (8-mm wheal) and negative to dust mites, cat, dog, tree pollens, weed pollens, and molds.