View Abstract

A3362 - Ticking Clock: A Woman with Life-Threatening Catamenial Angioedema
Author Block: A. Z. Rasheed1, M. Shahzadi2, L. N. Gerolemou3, V. P. Vasudevan4, F. Arjomand5; 1Pulmonary Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States, 2Pulmonology, Brooklyn, NY, United States, 3The Brooklyn Hospital Center, Brooklyn, NY, United States, 4Pulmonary Division, Internal Medicine, The Brooklyn Hospital, Brooklyn, NY, United States, 5Brooklyn Hosp Ctr, Brooklyn, NY, United States.
Introduction: Acute allergic reactions or exacerbations of preexisting chronic allergies in association with the female menstrual cycle are well documented for urticarial and bronchial asthma. The occurrence of anaphylaxis related to the menstrual period is rare. In some cases, certain drugs used for menstrual cramps or foods taken around the time of menstruation have been implicated. Our patient did not have any obvious cause despite exhaustive investigations. Catamenial anaphylaxis, also called cyclical anaphylaxis, describes recurrent episodes of multisystem allergic reactions occurring at the time of menstruation. We report a life-threatening perimenstrual angioedema reaction.Case Presentation: 48 years old female with past medical history of anxiety disorder and gestational DM presented with sudden onset of tongue and neck swelling, difficulty breathing and hoarseness of voice. She couldn't recall any allergies or triggering factors. She did not take any new OTC or prescribed medication. She had never been on ACEI or ARB. She was on Prozac and Clonipine that she had taken for years. She worked as counselor. She has no history of smoking, alcohol or substance abuse. She had never been on oral contraception or had IVF procedures done. She has two kids. She had been having itching and rash every month coinciding with her ovulation for 3 years and relieved by Benadryl. On physical examination she did not have any rash and her lungs were clear to auscultation. She did not has any leukocytosis. Eosinophil count, IgE levels, compliment levels, C1 esterase Inhibitor levels were normal. She was admitted to ICU and required treatment with Epinephrine, Benadryl, IV steroids and H2 blockers. Her symptoms improved in 24 hrs and she was discharged home.Discussion: Three main types of angioedema include, Histamine-mediated (Allergic, IgE-mediated), Bradykinin-induced (nonhistamine-mediated) and Idiopathic (mechanisms involve neither histamine nor bradykinin). Bradykinin-mediated angioedema comprises three distinct types: hereditary angioedema (HAE), acquired angioedema, and angiotensin-converting enzyme inhibitor (ACEi)-induced angioedema. Catamenial anaphylaxis is a heterogeneous disorder in which a number of mechanisms and mediators may play including hypersensitivity to progesterone or to prostaglandins. There are no guidelines for treatment as this a very rare entity. Cessation of the menstrual cycle by induction of medical or surgical menopause reportedly results in control of symptoms.