Furuto Yoshitaka, Nohara Takaya, Hamada Hirohisa, Shibuya Yuko
Department of Hypertension and Nephrology, NTT Medical Centre Tokyo, Tokyo, JPN.
Department of Emergency Medicine, NTT Medical Centre Tokyo, Tokyo, JPN.
Cureus. 2022 Jun 1;14(6):e25586. doi: 10.7759/cureus.25586. eCollection 2022 Jun.
Hypotension after exposure to an allergen is a well-known indicator of an anaphylactic reaction. However, hypertensive anaphylaxis often goes unrecognized. Increased blood pressure can present as an anaphylactic reaction, which is called hypertensive anaphylaxis. A 48-year-old woman complained of a tickle sensation in the throat and dyspnea 30 minutes after being administered the first dose of the Moderna coronavirus disease 2019 (COVID-19) vaccine. The patient had no history of hypertension, anxiety, or panic disorder. Forty-five minutes after the vaccination, stridor was noted, and the patient developed severe hypertension with a blood pressure of 197/153 mmHg. The patient also had tachycardia, cervical angioedema, and nausea, which occurred in a short period of time, indicating type I hypersensitivity reaction, that is, an anaphylactic reaction. The patient was diagnosed with Brighton classification Level 1 anaphylaxis caused by COVID-19 vaccination. For managing the patient, two intramuscular adrenaline injections, famotidine, chlorpheniramine, metoclopramide, and methylprednisolone were administered via intravenous infusion. After the administration of medications, all symptoms resolved, and the blood pressure was reduced. Other differential diagnoses for increased blood pressure after vaccination were excluded; therefore, we concluded that this phenomenon of increased blood pressure was hypertensive anaphylaxis. Not only hypotension but also the acute onset of increased blood pressure after vaccination may occur as a premonitory symptom of anaphylaxis. In hypertensive anaphylaxis, both anaphylaxis and increased blood pressure can be treated with intramuscular adrenaline injection. Clinicians should be aware of the occurrence of hypertensive anaphylaxis.
接触过敏原后出现低血压是过敏反应的一个众所周知的指标。然而，高血压性过敏反应往往未被识别。血压升高可表现为过敏反应，这种情况被称为高血压性过敏反应。一名48岁女性在接种第一剂莫德纳2019冠状病毒病（COVID-19）疫苗30分钟后，诉说喉咙有瘙痒感和呼吸困难。该患者无高血压、焦虑或惊恐障碍病史。接种疫苗45分钟后，出现喘鸣，患者血压急剧升高至197/153 mmHg，同时还出现心动过速、颈部血管性水肿和恶心，这些症状在短时间内出现，提示为I型超敏反应，即过敏反应。该患者被诊断为COVID-19疫苗接种引起的布莱顿分类1级过敏反应。为治疗该患者，通过静脉输注给予了两次肌内注射肾上腺素、法莫替丁、氯苯那敏、甲氧氯普胺和甲泼尼龙。用药后，所有症状均缓解，血压下降。排除了接种疫苗后血压升高的其他鉴别诊断；因此，我们得出结论，这种血压升高现象为高血压性过敏反应。接种疫苗后不仅可能出现低血压，还可能出现血压急性升高作为过敏反应的先兆症状。在高血压性过敏反应中，过敏反应和血压升高均可通过肌内注射肾上腺素进行治疗。临床医生应意识到高血压性过敏反应的发生。
