A masquerade of recurrent anaphylaxis

Area of Science:

• Pulmonology
• Allergy and Immunology
• Otolaryngology

Background:

• A 37-year-old male with a complex medical history presented with recurrent episodes of rash and respiratory distress.
• Symptoms were initially suspected to be anaphylaxis but lacked a clear trigger or etiology.
• Previous conditions included HIV, latent syphilis, anxiety, PTSD, ADHD, and multiple drug intolerance.

Observation:

• Diagnostic evaluation included laboratory analysis and direct visualization of the vocal cords via laryngoscopy.
• During an acute reaction, inappropriate adduction of the vocal cords was observed.
• This finding was key to differentiating the condition from true anaphylaxis.

Findings:

• The patient's symptoms were consistent with inducible laryngeal obstruction (ILO).
• ILO is a condition where the vocal cords close inappropriately during breathing.
• This diagnosis explained the recurrent respiratory symptoms without an allergic trigger.

Implications:

• The case underscores the importance of a comprehensive differential diagnosis for suspected anaphylaxis.
• Accurate diagnosis is crucial to avoid unnecessary treatments and manage the condition effectively.
• Recognizing ILO is vital for patients presenting with unexplained respiratory distress and rash.