Anaphylactic reactions presenting with hypertension

Solmazgül, Emrullah; Kutlu, Ali; Doğru, Salim; Özalper, Veysel; Çetindağlı, İbrahim; Sezer, Oğün; Salmanoğlu, Musa; Kılıç, Elif; Karabacak, Ercan; Öztürk, Sami

doi:10.1186/s40064-016-2913-y

Cited by 7 publications

(11 citation statements)

References 13 publications

(21 reference statements)

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“…Hypertensive anaphylaxis has been reported previously by Solmazgul et al [4]. Evidence demonstrates that internal compensatory vasopressor mechanisms are activated within minutes of anaphylaxis development, resulting in the release of endogenous vasoactive Fig.…”

Section: Discussionmentioning

confidence: 63%

“…At this patient's presentation, the recorded high blood pressure could be due to preexisting hypertension, anxiety leading to sympathetic activation, or both. Anaphylaxis-induced high blood pressure is another rare possibility [4]. The sympathetic activation in anxiety may have increased her blood pressure from baseline.…”

Section: Discussionmentioning

confidence: 99%

“…Solmazgul et al hypothesized that these initial compensatory mechanisms could be dominant in some patients, resulting in hypertension. This hypothesis was based on a case review of 62 patients who had anaphylaxis, and 8 of them were found to have high blood pressure at presentation [4]. A study on cardiovascular collapse due to anaphylaxis had shown initial vasoconstriction among 10 patients who presented with anaphylaxis [7].…”

Section: Discussionmentioning

confidence: 99%

“…As anaphylaxis is treated with intramuscular (IM) adrenaline, the decision to give adrenaline in the presence of hypertension is equally difficult. Anaphylaxis presenting with hypertension is rarely reported in the literature [4].…”

Section: Introductionmentioning

confidence: 99%

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An unusual presentation of anaphylaxis with severe hypertension: a case report

et al. 2022

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Background Low blood pressure and associated postural symptoms are well-recognized manifestations of anaphylaxis. Nonetheless, anaphylaxis can present with high blood pressure and is rarely reported in the literature. We report an unusual presentation of anaphylaxis with severe supine hypertension and orthostatic intolerance. Case presentation A 43-year-old Asian female presented to the emergency department with generalized itching, hives, and postural dizziness after taking a slow-release diclofenac sodium 100 mg tablet. On admission, the patient was tachycardic with a supine blood pressure of 200/100 mmHg. She had urticaria and bilateral rhonchi. A clinical diagnosis of anaphylaxis was made. She was treated with intravenous hydrocortisone and chlorpheniramine, but intramuscular adrenaline was withheld owing to her high blood pressure. She was kept in the supine position, and her vital parameters were closely monitored. Although the respiratory and cutaneous symptoms improved with treatment, her blood pressure remained elevated. Forty minutes later, the postural dizziness recurred as she sat up on the bed and her blood pressure plummeted from 198/100 mmHg to 80/60 mmHg. She was put back in the supine position immediately, and the blood pressure was restored with three doses of intramuscular adrenaline and a fluid bolus. Her postural symptoms completely resolved after adrenaline, but her blood pressure remained elevated. Two weeks after the initial presentation, a diagnosis of essential hypertension was made, which probably had been undetected. In anaphylaxis, where the cardiovascular system is involved, a blood pressure reduction from baseline is expected in patients with preexisting hypertension. Despite cardiovascular involvement, our patients’ blood pressure on presentation to the emergency department was much higher than her pretreatment ambulatory blood pressure, thus making this presentation unusual. Conclusions Diagnosis and treatment of anaphylaxis can be delayed in patients presenting with high blood pressure. Postural symptoms should alert the clinician to cardiovascular involvement despite elevated supine blood pressure. Early treatment with adrenaline should be considered in these patients with extreme caution.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An unusual presentation of anaphylaxis with severe hypertension: a case report

et al. 2022

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“…BP increased until anaphylaxis treatment was administered and transiently increased after AD injection; however, BP improved approximately 30 minutes thereafter. Although there are a few case reports about HA [ 3 , 13 ], it may occur in anaphylaxis induced by an allergen and not only in Moderna COVID-19 vaccination. It was reported that the rate of HA among anaphylaxis patients was 12.9%.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive Anaphylaxis After Moderna COVID-19 Vaccination: A Case Report

Furuto¹,

Nohara²,

Hamada³

et al. 2022

Cureus

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Hypotension after exposure to an allergen is a well-known indicator of an anaphylactic reaction. However, hypertensive anaphylaxis often goes unrecognized. Increased blood pressure can present as an anaphylactic reaction, which is called hypertensive anaphylaxis. A 48-year-old woman complained of a tickle sensation in the throat and dyspnea 30 minutes after being administered the first dose of the Moderna coronavirus disease 2019 (COVID-19) vaccine. The patient had no history of hypertension, anxiety, or panic disorder. Forty-five minutes after the vaccination, stridor was noted, and the patient developed severe hypertension with a blood pressure of 197/153 mmHg. The patient also had tachycardia, cervical angioedema, and nausea, which occurred in a short period of time, indicating type I hypersensitivity reaction, that is, an anaphylactic reaction. The patient was diagnosed with Brighton classification Level 1 anaphylaxis caused by COVID-19 vaccination. For managing the patient, two intramuscular adrenaline injections, famotidine, chlorpheniramine, metoclopramide, and methylprednisolone were administered via intravenous infusion. After the administration of medications, all symptoms resolved, and the blood pressure was reduced. Other differential diagnoses for increased blood pressure after vaccination were excluded; therefore, we concluded that this phenomenon of increased blood pressure was hypertensive anaphylaxis. Not only hypotension but also the acute onset of increased blood pressure after vaccination may occur as a premonitory symptom of anaphylaxis. In hypertensive anaphylaxis, both anaphylaxis and increased blood pressure can be treated with intramuscular adrenaline injection. Clinicians should be aware of the occurrence of hypertensive anaphylaxis.

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