A 42-year-old previously healthy man presents to the emergency department after collapsing
during a morning jog. Bystanders report that he suddenly became flushed, complained
of intense itching, developed wheezing, and briefly lost consciousness. EMS noted
hypotension (BP78/40 mmHg) and urticaria. He improved rapidly after intramuscular
epinephrine.
He reports three similar episodes over the past year, all occurring during exercise.
Between episodes, he feels entirely well.
He has no history of asthma, food allergies, cardiovascular disease, ingestion of
new medications, or a family history of sudden death.
His workup, which included a detailed physical examination, a fasting blood glucose
level, serum tryptase levels, liver chemistries, urinalysis, CBC, EKG, ECHOcardiogram,
and an exercise stress test were all normal.
What is your diagnosis, what test or tests would you order to confirm your suspicions,
and what treatment, if any, do you recommend?
In order to receive credit, please email your answers to smithj@etsu.edu.