Anaphylaxis versus inducible laryngeal obstruction: a diagnostic dilemma

Inducible laryngeal obstruction (ILO) is an under-recognised cause of refractory breathlessness. It presents with an acute onset of difficulty in breathing and is often mistaken for respiratory conditions such as asthma or, in some cases, anaphylaxis. People with ILO often report recurrent Accident & Emergency attendances and have long-term drug treatments initiated and escalated inappropriately. The cornerstone of ILO management is speech and language therapy, and it is essential that cases are identified promptly to ensure they are managed correctly. By doing this, patients can be supported with education and therapeutic strategies, thus reducing associated distress, unnecessary pharmacotherapy and overall healthcare utilisation. In this case study, we describe a patient who was diagnosed and successfully treated for ILO after initially being investigated for recurrent anaphylaxis. She had a significant symptom burden with multiple hospital admissions and relied on epinephrine to manage these episodes. Following specialist assessment and treatment, she was subsequently weaned off potentially dangerous medications that were not clinically indicated, while reporting a marked improvement in her quality of life (see Patient's perspective below).