4回のアドレナリン投与を要したカシューナッツによるアナフィラキシーショックの1例

抄録

A 6-year-old boy with a history of urticaria reacting to cashew nuts accidentally ingested three cashews during school lunch. He experienced nausea but was able to clean the classroom. He developed a rash and itching after classroom cleaning. He took olopatadine hydrochloride but showed no improvement. On discovering that he had accidentally ingested cashew nuts, an ambulance was called to transfer him to our hospital. He showed tachycardia at 132 bpm with a blood pressure of 88/38 mmHg, and anaphylaxis was highly suspected. He was diagnosed with anaphylactic shock due to generalized erythema, tachycardia, mild hypotension, and drowsiness; he was promptly given an intramuscular adrenaline injection. He required three further intramuscular adrenaline injections: two were due to prolonged hypotension, and one was due to respiratory distress and hypoxemia. This case was unusual because the patient necessitated four intramuscular injections of adrenaline. Four factors contributed to the incident: the food being cashews, the boy performing physical activity after the ingestion, the delay in initial treatment, and the failure to administer intramuscular adrenaline injection at the appropriate time. Early intramuscular injection of adrenaline is important to prevent severe anaphylaxis.