The Journal of Allergy and Clinical Immunology
Volume 116, Issue 3 , Page 710, September 2005

Factitious anaphylaxis and prevarication anaphylaxis

Vancouver General Hospital, University of British Columbia, 750 West Broadway, Suite 1200, Vancouver, BC, V5Z 1J2, Canada

published online 01 July 2005.

Article Outline

 

To the Editor:

The updated practice parameter on the diagnosis and management of anaphylaxis by Lieberman et al1 provides an excellent and most comprehensive review on this subject.

Several cases of factitious anaphylaxis were described by Patterson et al.2, 3, 4 They included self-induced laryngeal strider,2 nut-induced anaphylaxis,3 and aspirin-induced anaphylaxis presenting as factitious Hymenoptera allergic emergency4 as variants of Munchausen's syndrome.

Patterson et al5 also summarized the characteristics of 4 patients with prevarication anaphylaxis, without detailed histories or challenge studies.

A case report of Munchausen's syndrome presenting as prevarication anaphylaxis was described on a woman in her mid-20s with a past history of psychiatric illnesses, multiple recent emergency department visits and hospital admissions for alleged anaphylaxis in various cities across Canada, absence of abnormal physical and laboratory findings, and a clinical defect questioned by an attending psychiatrist to have been manufactured by the patient.6 Single-blind placebo-controlled oral challenge for an alleged sensitivity to tartrazine resulted in “anaphylaxis” with laryngeal involvement only with placebo.

Both factitious anaphylaxis and prevarication anaphylaxis, or Munchausen's anaphylaxis, should be included in the types of anaphylaxis and the differential diagnosis of anaphylaxis and anaphylactoid reactions.

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References 

  1. Lieberman P, Kemp SF, Oppenheimer J, Lang DM, Bernstein IL, Nicklas RA, et al. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. 2005;115:S483–S523
  2. Patterson R, Schatz M, Horton M. Munchausen's stridor: non-organic laryngeal obstruction. Clin Allergy. 1974;4:309–310
  3. Patterson R, Schatz M. Factitious allergic emergencies: anaphylaxis and laryngeal “edema”. J Allergy Clin Immunol. 1975;56:152–159
  4. Hendrix S, Sale S, Zeiss CR, Utley J, Patterson R. Factitious Hymenoptera allergic emergency: a report of a new variant of Munchausen's syndrome. J Allergy Clin Immunol. 1981;67:8–13
  5. Patterson R, Dykewicz MS, Grammer LC, Greenberger PA, Lawrence ID, Walker CL, et al. Classification of immediate-type life-threatening allergic or pseudoallergic reactions. Chest. 1990;98:257–259
  6. Wong HCG. Munchausen's syndrome presenting as prevarication anaphylaxis. Can J Allergy Clin Immunol. 1999;4:299–300

PII: S0091-6749(05)01282-0

doi:10.1016/j.jaci.2005.04.040

The Journal of Allergy and Clinical Immunology
Volume 116, Issue 3 , Page 710, September 2005

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