Payus Alvin Oliver, Ibrahim Azliza, Mustafa Norlaila
Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia.
Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia.
Open Access Maced J Med Sci. 2018 Nov 19;6(11):2136-2138. doi: 10.3889/oamjms.2018.317. eCollection 2018 Nov 25.
Anaphylaxis often misdiagnosed and treated as acute asthma, especially when it has a predominant respiratory symptom, and there are no obvious precipitants or previous allergic history. This morbid outcome is preventable if the level of suspicion for anaphylaxis is high among healthcare provider when treating a patient who is not responding to the standard management of acute asthma. A proportion of anaphylactic patient shows a biphasic reaction which potentially fatal when it is under-anticipated and prematurely discharge without adequate observation period after the recovery of the initial episode.
Here, we present a case of a young man who has childhood asthma with the last attack more than 10 years ago presented with symptoms suggestive of acute exacerbation of bronchial asthma. As the symptoms failed to improve after standard asthma management, anaphylaxis was suspected, and he was given intramuscular adrenaline 0.5 mg which leads to symptom improvement. However, he developed another attack shortly after improvement while under observation.
The objective of this case report is to emphasise the importance of keeping anaphylaxis in mind whenever a patient has treatment-refractory asthma, and also the anticipation of biphasic reaction that warrants adequate observation period especially those who are likely to have developed it.
过敏反应常被误诊为急性哮喘并进行治疗，尤其是当它以呼吸道症状为主，且无明显诱发因素或既往过敏史时。如果医疗人员在治疗对急性哮喘标准治疗无反应的患者时，对过敏反应的怀疑程度较高，这种不良后果是可以预防的。一部分过敏患者会出现双相反应，如果在初次发作恢复后未得到充分观察期就过早出院且未预料到这种反应，可能会致命。
在此，我们报告一例年轻男性病例，他有儿童哮喘病史，上次发作在10多年前，此次出现提示支气管哮喘急性加重的症状。在进行标准哮喘治疗后症状未改善，怀疑为过敏反应，给他注射了0.5毫克肌肉注射肾上腺素，症状得到改善。然而，在观察期间，症状改善后不久他又发作了一次。
本病例报告的目的是强调每当患者有治疗难治性哮喘时，要牢记过敏反应的重要性，以及对双相反应的预期，这需要足够的观察期，尤其是那些可能发生双相反应的患者。
