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Protracted Anaphylaxis and Treatment Resistant Angioedema: Looking Beyond Ingestions and Skin
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A1252 - Protracted Anaphylaxis and Treatment Resistant Angioedema: Looking Beyond Ingestions and Skin
Author Block: M. Winikor1, J. Xu2, J. Stoll2, W. Khan3; 1Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States, 2Internal Medicine, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, United States, 3University Medical Center of Princeton Plainsboro, Plainsboro, NJ, United States.
Introduction: Anaphylaxis with angioedema is a common reason for admission to a critical care unit. Most cases are due to ingestion or skin exposure, with resolution occurring within twenty-four hours. Protracted anaphylaxis, defined as anaphylaxis lasting from hours to days after initial exposure without complete resolution, is rarely reported and the frequency of such reactions remains unknown. Furthermore, anaphylaxis due to intravenous vaccinations is rare. We report a case of protracted anaphylaxis to Hepatitis A vaccination.
Case Report: The patient is a 57-year-old female who presented with dyspnea, wheezing, throat tightness and worsening angioedema of the face. She was admitted to the critical care unit, where an extensive review of her history did not reveal any suspicious ingestion or skin exposure. The patient was treated with parenteral antihistamines and high dose methylprednisolone. However, her symptoms including angioedema persisted, with further development of hives and lip paresthesia. Intermittent epinephrine IM injection provided temporary relief. Further exploration of her history revealed that the patient received the Hepatitis A vaccination two days prior to onset of symptoms. Treatment with systemic glucocorticoids continued for 2 weeks with a combination of diphenhydramine, famotidine, certirizine, montelukast, and hydroxyzine added. The patient slowly improved on this regimen.
Clinical significance: We report a unique case of protracted and treatment resistant anaphylaxis to Hepatitis A vaccination. Protracted anaphylaxis is not widely reported and current literature is limited to case reports and small case series. Although rare, the clinician should be aware of the possibility of protracted anaphylaxis. Furthermore, severe allergic reactions to vaccinations are uncommon with the rate of anaphylactic reactions to vaccines ranging from 0.65 to 1.31 events per million vaccine doses. We aim to bring awareness of this potential complication of vaccinations.
Author Block: M. Winikor1, J. Xu2, J. Stoll2, W. Khan3; 1Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States, 2Internal Medicine, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, United States, 3University Medical Center of Princeton Plainsboro, Plainsboro, NJ, United States.
Introduction: Anaphylaxis with angioedema is a common reason for admission to a critical care unit. Most cases are due to ingestion or skin exposure, with resolution occurring within twenty-four hours. Protracted anaphylaxis, defined as anaphylaxis lasting from hours to days after initial exposure without complete resolution, is rarely reported and the frequency of such reactions remains unknown. Furthermore, anaphylaxis due to intravenous vaccinations is rare. We report a case of protracted anaphylaxis to Hepatitis A vaccination.
Case Report: The patient is a 57-year-old female who presented with dyspnea, wheezing, throat tightness and worsening angioedema of the face. She was admitted to the critical care unit, where an extensive review of her history did not reveal any suspicious ingestion or skin exposure. The patient was treated with parenteral antihistamines and high dose methylprednisolone. However, her symptoms including angioedema persisted, with further development of hives and lip paresthesia. Intermittent epinephrine IM injection provided temporary relief. Further exploration of her history revealed that the patient received the Hepatitis A vaccination two days prior to onset of symptoms. Treatment with systemic glucocorticoids continued for 2 weeks with a combination of diphenhydramine, famotidine, certirizine, montelukast, and hydroxyzine added. The patient slowly improved on this regimen.
Clinical significance: We report a unique case of protracted and treatment resistant anaphylaxis to Hepatitis A vaccination. Protracted anaphylaxis is not widely reported and current literature is limited to case reports and small case series. Although rare, the clinician should be aware of the possibility of protracted anaphylaxis. Furthermore, severe allergic reactions to vaccinations are uncommon with the rate of anaphylactic reactions to vaccines ranging from 0.65 to 1.31 events per million vaccine doses. We aim to bring awareness of this potential complication of vaccinations.
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