Published 9 March 2009, doi:10.1136/bmj.b846
Cite this as: BMJ 2009;338:b846

Practice

Commentary: Think anaphylaxis

¹ Departments of Internal Medicine and Immunology, Erasmus Medical Centre, Rotterdam 3015 GD, Netherlands

doi:10.1136/bmj.b246doi:10.1136/bmj.b247doi:10.1136/bmj.b799doi:10.1136/bmj.b796

The first 150 words of the full text of this article appear below.

Collapse is a commonly encountered problem in the emergency department. Its causes are many and varied, and some are potentially life threatening.¹ In this interactive case report, Mrs Barroso presented with recurrent collapses coinciding with the onset of menstruation.² Given her rapid response to steroids, I would have thought initially that she had adrenal insufficiency. In fact, most of the respondents on bmj.com concluded the same.³ Based on the lack of response to vasoactive drugs, I would have discarded a diagnosis of anaphylaxis. Corticosteroids are usually effective only in preventing the biphasic or protracted reactions, and even this is questioned.⁴

We were all wrong. Mrs Barroso did present with an anaphylactic reaction secondary to an underlying systemic mastocytosis. But could we have foreseen that we were wrong?

In retrospect we can. In the presentation of the case there were some clues that might have prompted the correct diagnosis. The diarrhoea . . . [Full text of this article]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Interactive case reports

Fiona Godlee
BMJ 2009 338: b1012. [Extract] [Full Text]

A 38 year old woman with hypotensive shock at the onset of menstruation: case outcome

Sergio Serrano Villar, Juncal Perez-Somarriba, Talia Sainz Costa, Sarah Winstanley, Tomas Santillana Lopez, Luis Escribano Mora, and Baltasar Orejas Gonzalez
BMJ 2009 338: b247. [Extract] [Full Text]

Commentary: The value of complexity

Ed Peile
BMJ 2009 338: b796. [Extract] [Full Text]

Commentary: Condition is often overlooked

Gerhard J Molderings
BMJ 2009 338: b799. [Extract] [Full Text]

Commentary: Patient’s view

Mrs Barroso with the support of Sergio Serrano Villar
BMJ 2009 338: b867. [Extract] [Full Text]

Commentary: Managing clinician’s assessment

Sergio Serrano Villar
BMJ 2009 338: b868. [Extract] [Full Text]

A 38 year old woman with hypotensive shock at the onset of menstruation: case progression

Sergio Serrano Villar, Juncal Perez-Somarriba, Talia Sainz Costa, Sarah Winstanley, Tomas Santillana Lopez, Luis Escribano Mora, and Baltasar Orejas Gonzalez
BMJ 2009 338: b246. [Extract] [Full Text]

A 38 year old woman with hypotensive shock at the onset of menstruation: case presentation

Sergio Serrano Villar, Juncal Perez-Somarriba, Talia Sainz Costa, Sarah Winstanley, Tomas Santillana Lopez, Luis Escribano Mora, and Baltasar Orejas Gonzalez
BMJ 2009 338: b6. [Extract] [Full Text]

Online poll

Find out more here>> and here>>