Sudden-onset fatal or near-fatal asthma is a previously described rare subset of asthma. Allergic etiology was investigated in this patient, who had an additional risk factor for fatal or near-fatal outcome.

A 53-year old white female, with an 8-year history of mild intermittent asthma, suffered two months of progressive worsening. This culminated in two severe rapid exacerbations, with cardiopulmonary arrest requiring CPR and ICU admissions; the second occurred while still taking oral prednisone. She reported multiple pets at home, but minimal allergic symptoms. ImmunoCAP testing for specific IgE demonstrated antibody to cat above the limits of measurement, antibody to dog of 81, and antibody to rabbit of 11. She also received echocardiography and cardiac catheterization, which demonstrated EF of 35% without underlying cardiovascular lesion. She was discharged on multiple asthma controller medications (including prednisone taper), and directed to find accommodations devoid of pet allergen.

At two-weeks, she had no complaints asthma symptoms, but persistently abnormal spirometry.

Sudden-onset near-fatal asthma is a previously described rare subset of asthma. Previous studies have demonstrated that patients have a large neutrophilic infiltration, rather than eosinophilic. Additionally, triggers are generally allergic, rather than infectious. This patient had strikingly elevated IgE to several of her household pets, despite minimal rhino-ocular symptoms. She had an additional risk factor of reduced cardiac function, believed to be a result of prior chemotherapy. This combination of risks led to rapid recurrence of near-fatal outcome, despite systemic glucocorticoid therapy.