Twice Too Many: Dilemma in Managing a Patient With Recurrent Near-death Events in Primary Care

Abstract

A 45-year-old man with diabetes, hypertension, dyslipidaemia, asthma, and gout presented after switching his oral anti-diabetes therapy from ertugliflozin to dapagliflozin, both SGLT2 inhibitors. Within a week, he suffered two anaphylactic attacks following urticarial episodes. Although allergic reactions to switching SGLT2 inhibitors are rare, the temporal relationship suggested a possible trigger. An allergy panel revealed high titres for house dust mites (HDM) and crab, prompting a review of his history. It was found that he had recently done spring cleaning and consumed seafood (crabs) before the anaphylaxis. This critical detail was missed in the initial consultation. After confirming the allergen sources, SGLT2 inhibitor therapy was safely resumed. The patient was advised to carry adrenaline auto-injectors for emergencies. This case underscores the need for greater awareness of IgE cross-reactivity among primary care doctors.