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Intriguing Cases

Simple reactions and combination reactions

Dr David L. J. Freed, MB, MD, MIBiol

The 30-year old nurse that I saw in 1984. She had such crippling paroxysmal tachycardias (bouts of racing pulse) that the cardiologist had fitted her with a sophisticated computerised pacemaker that switched itself on whenever she started an attack (at the cost of a minor operation to fit the device and several thousands of pounds). When she stopped drinking tea and coffee the attacks completely ceased.

But not all cases are that simple. Sometimes several factors are required to come together before the symptoms appear - I remember the 30-year old mother who developed asthma, but only on a day when she had inhaled chemical fumes, provided she had also drunk coffee with milk - and then only when she was pregnant! Or the cases of food-induced anaphylaxis (allergic collapse, sometimes fatal) that occur only when the culprit food has been eaten on a day when the patient has also undergone strenuous physical exertion or emotional stress. Or the child who had an attack of urticaria (hives) whenever he ate ice-cream with peaches - ice-cream by itself, and peaches alone, caused no problem even if eaten in huge quantities.

Luckily, it is not usually necessary to remove all the factors;
once we bring one under control the others often cease to cause problems. Sort out the food allergy by desensitisation, and they can do as much exercise as they like.

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