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  Authority of Polish Society of Allergology

vol 19. no 3. September 2014  

 Original articles
Urticaria after EBV infection, uncontrolled exercise-induced asthma as well as - combined fructose and lactose intolerance were mimicking anaphylaxis in a 12-yr boy. Case report
Michał Pudełko, Ewa Cichocka-Jarosz, Joanna Nizio-Mąsior, Grzegorz Lis

Twelve year old boy was admitted to the University Children’s Hospital
for suspected anaphylaxis. Six months before admission he presented
acute episodes of urticaria, paleness of the face and weakness after exercises.
The episodes, accompanied by abdominal pain, were becoming
more frequent. He required three times emergency intervention for self-
perceived dyspnoea (though without objective symptoms of airway
obstruction or arterial blood pressure lowering). Differential diagnostic
procedures performed at the hospital ruled out atopy, anaphylaxis, including
food dependent exercise induced anaphylaxis (FDEIA), immunological
disorders (disorders of humoral immunity, complement-dysfunction,
autoimmunization), focal infections, including parasites, as well as mast
cells disorders. Lung function tests showed one single positive exercise
challenge test result with subsequent giant urticaria. Due to abdominal
pain accompanying physical exercise, diagnostic procedures were extended
and the patient was finally diagnosed with both lactose and fructose
intolerance. Because of some psychosomatic signs, psychotherapy was
started in the patient. After implementation of combined aerosol therapy
(glucocorticosteroid and long acting beta2 agonist) before exercise in
combination with elimination diet, the symptoms receded and were not
observed during one year of follow-up.

keywords: pokrzywka, astma, nietolerancja fruktozy, nietolerancjalaktozy, anafilaksja, dzieci, diagnostyka różnicowa, urticaria, asthma, fructose intolerance, lactose intolerance anaphylaxis, children, differential diagnosis

pages: from 181 to 181

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