Atrial fibrillation associated with anaphylaxis during venom and pollen immunotherapy

Abstract

Background: Electrographic changes after insect stings have been reported both with and without systemic symptoms. To our knowledge, however, there have been no reported cases of arrhythmias in the maintenance phase of venom or pollen immunotherapy.

Objective: We report a case of a patient who developed paroxysmal atrial fibrillation after receiving venom and pollen immunotherapy. This patient was initially evaluated in an outpatient setting, and the events described occurred at an allergist's private office. We believe this is an atypical presentation and would be very pertinent to the practicing allergist.

Methods: This patient was under the care of a clinical allergist in a private practice with associations to a teaching hospital. Interventions were as described in the body of the paper, more specifically venom and pollen maintenance immunotherapy followed by two doses of 0.3 mL of 1:1,000 concentration epinephrine intramuscularly.

Results: Patient was found to be in atrial fibrillation along with systemic symptoms immediately after administration of immunotherapy. After epinephrine administration, patient converted back to normal sinus rhythm and systemic symptoms resolved.

Conclusions: Atrial fibrillation is an atypical presentation of a systemic reaction to immunotherapy.