Recurrent Idiopathic Anaphylaxis in a Woman after Suspected Food Poisoning
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Carl B. Lauter, MD, FAAAAI

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 GI infections) and chronic idiopathic urticaria (CIU) 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 jejuniinfection and urticaria is reviewed.  Gastrointestinal infections (Giardia, Anisakis) have been better documented in such patients.

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

Conclusions:   Chronic urticaria and recurrent bouts of mild unexplained anaphylaxis were triggered by Campylobacter jejuni infection.  The allergic and GI symptoms resolved after treatment.  Gastrointestinal infections should be looked for in patients with urticaria or anaphylaxis.