Q:

6/27/2013
We have a patient who recently started immunotherapy after testing 3+-4+ to the majority of the trees, grasses, weeds, molds, Dust Mites, Cat and Cockroach on our board. She was also positive at similar levels to many of the foods. Both the provider and myself have discussed environmental controls but I'm getting the impression from this patient that it goes in one ear and out the other. Since starting her immunotherapy 9 weeks ago, she continues to experience a metallic taste in her mouth soon or later in the day after receiving the injections. I've spoken to the physician about this as well, who does not know the reason for this. The patient has not had any other problems with her shots. She stated that she read on the internet that this metallic taste is a precursor to anaphylaxis. Is this true? Thank you for your time.

A:

Thank you for your inquiry.

A metallic taste has been noted to be a prodrome of anaphylactic events along with other symptoms such as itching and paresthesias of the palms and soles, sweating, headache, or disorientation (1). However, the full-blown episode of anaphylaxis occurs shortly after these earlier noted manifestations. I am not aware of isolated episodes of metallic taste, not followed by a full-blown episode of anaphylaxis, being noted as a risk factor for future events. Thus, I know of no evidence to support your patient’s metallic taste as placing her at increased risk of an anaphylactic episode in the future. That is, metallic taste has been noted to occur early in the course of an event, but never as an isolated indication that that may occur in the future. I also could not find any indication that isolated episodes of metallic taste would place her at risk of an anaphylactic episode via a literature search.

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

Reference:
1. Ring J, et al. History and classification of anaphylaxis. In: anaphylaxis: Novartis Foundation, published by Wiley in 2004, Page 8.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology