Management of maternal anaphylaxis in pregnancy: a case report

Abstract

Case: A 26-year-old woman (gravida 2, para 1) at 25 weeks' gestation was brought to the emergency department because of anaphylactic symptoms. She reported eating Japanese soba and developed symptoms of dyspnea, generalized itchy rash, abdominal pain, and severe uterine contractions within 15-30 min of eating. She was immediately treated by normal saline infusion, two injections of epinephrine (intramuscularly), and a nebulized short-acting β₂-receptor agonist, followed by H₁-antihistamine and methylprednisolone. Obstetrical management was undertaken by an obstetrician.

Outcome: The patient recovered rapidly without a biphasic reaction of anaphylaxis. After 11 weeks, a healthy, neurologically intact baby was born.

Conclusion: Management of anaphylaxis in pregnant patients is basically the same of that in non-pregnant ones. Treatment should commence immediately to prevent further development of the anaphylaxis reaction and fetal neurological deficiency.

Keywords: Anaphylactic shock; fetal brain damage; fetal distress; food allergy.

Figure 1

Fetal heart rate during maternal anaphylaxis. The mother experienced strong and frequent uterine contractions (lower panel), but examination of the fetus revealed a normal heart rate (140–160 b.p.m) with variability (upper panel).