Chong Kok Wee, Ling Simon, Loh Wenyin
Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899.
Neurology Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899.
Asia Pac Allergy. 2018 Mar 3;8(2):e13. doi: 10.5415/apallergy.2018.8.e13. eCollection 2018 Apr.
Wheat allergy is one of the commonest food allergies in childhood and it typically presents with IgE mediated reactions, including anaphylaxis. Seizures are not typically reported to be a direct manifestation of anaphylaxis, though it can occur secondary to hypoxia following significant haemodynamic compromise. We describe a case of a previously well infant, who presented with anaphylactic shock to wheat and responded well to the initial management, but subsequently developed a cluster of brief generalised tonic clonic seizures without any ongoing haemodynamic instability. The tryptase level that was performed at 4-5 hours post reaction was raised at 49.1 µg/L. Skin prick test to wheat, wheat specific IgE, the omega-5 gliadin IgE were positive. Extensive work-up was performed to look for an underlying cause of seizures and all returned negative. To our knowledge, this is the first case report describing an unusual presentation of multiple seizures in a young infant, in association with an anaphylactic episode. In the absence of any other seizure provoking factor and underlying cause, we believe the association is more likely causative than coincidental.
小麦过敏是儿童期最常见的食物过敏之一，通常表现为IgE介导的反应，包括过敏反应。虽然过敏反应继发严重血流动力学障碍后的缺氧可导致癫痫发作，但癫痫发作通常不被认为是过敏反应的直接表现。我们报告一例既往健康的婴儿，该婴儿因小麦过敏发生过敏性休克，初始治疗反应良好，但随后出现一系列短暂的全身性强直阵挛发作，且无持续的血流动力学不稳定。反应后4 - 5小时检测的类胰蛋白酶水平升高至49.1µg/L。小麦皮肤点刺试验、小麦特异性IgE、ω-5麦醇溶蛋白IgE均为阳性。进行了全面检查以寻找癫痫发作的潜在原因，结果均为阴性。据我们所知，这是首例描述幼婴出现与过敏发作相关的多次癫痫发作异常表现的病例报告。在没有任何其他癫痫诱发因素和潜在病因的情况下，我们认为这种关联更可能是因果关系而非巧合。
