A 71-year-old man with anaphylaxis after eating grits

Abstract

The allergist is frequently called on to evaluate patients after episodes of anaphylaxis to determine the cause and implement preventive measures that will reduce the patient's risk from future episodes. The etiology of anaphylaxis can be the result of numerous causes that may go undiagnosed if a thorough evaluation is not performed. We present a 71-year-old man with no history of food allergy or atopy who presented to the emergency room and then our allergy clinic for evaluation after suffering anaphylaxis after a meal of grits and shrimp. The underlying diagnosis, which was subsequently determined, requires a high index of suspicion and should be included in the differential diagnosis of any patient presenting with unexplained anaphylaxis. CASE PRESENTATION Chief ComplaintFood-induced anaphylaxis. History of Present IllnessA 71-year-old man with a history of hypertension, gastroesophageal reflux, and dyslipidemia presented to our clinic after an allergic reaction. His allergic reaction occurred within 1 hour of his evening meal, which consisted of shrimp with grits and bacon. The reaction started with his eyes becoming itchy and watery, followed by nasal congestion and clear rhinorrhea. His tongue and lip then became swollen and he had excessive drooling. He developed an itchy rash on his arms and full body flushing. Next, he experienced shortness of breath, which prompted him to seek emergency medical care. He denied nausea, diarrhea, abdominal cramps, light headedness, or syncope. After evaluation in the emergency room, he was treated with methylprednisolone, diphenhydramine, and nebulized epinephrine. He was admitted for observation but had no further symptoms and was discharged home with an epinephrine autoinjector device and a prednisone taper and told to avoid seafood.He presented to our clinic the next day. He had no similar prior episodes. He denied any history of atopic disease. He had eaten shrimp from the same bag and not had similar reactions. His wife consumed the same meal that he did and did not have similar symptoms. His review of systems was unremarkable. His medications had not changed recently. He had no known drug allergies and specifically no history of reactions to non-steroidal antiinflammatory drugs (NSAIDs).