Q:

7/31/2014
A 52 year-old female was referred for an allergic reaction during Thallium stress test. She has no major medical problems except hypertension treated with Losartan, mild allergic rhinitis due to dust mite allergy and very mild intermittent asthma treated with albuterol as needed.

She had IV placed with normal saline in Nuclear medicine department, went for stress test, walked for about 9 min on treadmill, was given IV Thallium, she walked for 1 more minute and was lying down. 3-4 min after Thallium, she started with itching inside her mouth followed by tongue swelling and severe lower lip swelling, redness over arms and chest (no itching), dry eyes, she had hard time swallowing, no SOB, cough, chest tightness, hives or GI symptoms. She was taken to ER where she received IV Benadryl and methyl prednisolone with significant improvement in her symptoms. She had mild lip swelling at the time of discharge which resolved next morning, did not take any more Benadryl, continued her Prednisone for 2 more days. She takes Losartan daily (did not take any that morning) and has taken it since then without any reaction.

She did not eat any breakfast that morning, she is not allergic to latex. Exercise induced anaphylaxis is a possibility though less likely. I could not find anything in literature about allergic reaction to Thallium. I would appreciate your input.

A:

Thank you for your inquiry.

Actually, I have little to add to the differential diagnosis that you have already considered. I am not aware of any anaphylactic or, for that matter, non-anaphylactic allergic reaction to Thallium and could find no reports of this in the literature. I agree with you that the symptoms are somewhat unusual for exercise-induced anaphylaxis, but in the absence of any other suggested trigger, I believe we might have to accept, at least at this time, an exercise-related event.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology