Recurrent Idiopathic Anaphylaxis in a Woman After Suspected Food Poisoning

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Abstract

Rationale

Recurrent idiopathic anaphylaxis represents a vexing clinical problem associated with stress for patients and allergists. The cause is often not identified despite exhaustive testing.

Methods

The history of a 54-year old woman with repeated bouts of unexplained anaphylaxis is reviewed. The relationship between preceding or active infection (emphasis on gastrointestinal infections) and chronic idiopathic urticaria and anaphylaxis was explored by electronic media search (PubMed, Google) and review of reference lists of published articles. The literature on the relationship of Campylobacter jejuni infection and urticaria is reviewed. Gastrointestinal infections (Giardia, Anisakis) have been better documented in such patients.

Results

The patient had persistent flatulence, and looser and more frequent bowel movements for months after recovery from a bout of food poisoning. A diagnosis of “postinfectious irritable bowel syndrome” was made by a gastroenterologist. These symptoms were not related to her simultaneous diagnosis of chronic idiopathic urticaria and idiopathic anaphylaxis. After treatment with azithromycin (positive stool culture for C. jejuni), she had a systemic allergic reaction. Subsequently, the diarrhea and urticaria/anaphylaxis cleared. C. jejuni has been reported to cause chronic urticaria, but predominantly in children. A related organism, Helicobacter pylori, has been associated with chronic idiopathic urticaria. Anaphylaxis has not been related to Campylobacter infection in the past.

Conclusions

Urticaria and recurrent bouts of mild unexplained anaphylaxis were triggered by C. jejuni infection. The allergic and gastrointestinal symptoms resolved after antibiotic treatment. Gastrointestinal (and other) infections should be looked for in patients with urticaria or anaphylaxis

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