2018 Volume 32 Issue 2 Pages 230-235
Anaphylactic symptoms and psychogenic reaction are sometimes difficult to distinguish. An 11-year-old boy with no history of allergies presented to the emergency department with dyspnea after eating one-eighth of an apple. He was diagnosed with anaphylaxis (An) and given intramuscular adrenaline injection and other anaphylactic treatments. Subsequently, he was referred to our hospital for further examination. With open oral food challenge, dyspnea developed after eating one-eighth of an apple. Upon determining that he was suffering from An, he was administered intramuscular adrenaline. Thirty minutes later, he lapsed into hyperventilation, and was treated with bag rebreathing. As we suspected the possibility of a psychogenic reaction, we interviewed the patient about his daily life, through which his hectic lifestyle was revealed. Subsequent blind oral food challenge to apple was negative ; therefore, we strongly suspected the manifestation of a psychogenic reaction. Findings from an interview with his mother conducted by a clinical psychologist strongly indicated that he might have been experiencing emotional conflicts, stress and frustrations with his family relationships, cramming in school, and participating in sports activities. He was given counseling, which resolved the symptoms, suggesting that potential involvement of psychogenic factors should be considered in anaphylactic-like conditions in adolescent patients.
