Near fatal asthma after eating deeply frozen ice cream.

Case Report A women aged 20 with a long history of mild asthma, requiring only occasional puffs of salbutamol, was admitted with an attack of fulminating asthma. She had been well on the day of admission and had not required her Ventolin inhaler. She had hurriedly consumed a quantity of deeply frozen ice cream straight from the deep freeze. She had enjoyed the same ice cream many times without ill effects but had never eaten it deeply frozen. Within five minutes of eating the ice cream she felt tight chested and wheezy. The symptoms rapidly progressed over the next five to ten minutes and she became extremely distressed and cyanosed, and was thought by her father to have stopped breathing. He gave her the kiss of life and artificial ventilation was continued in the ambulance. On arrival at the Cambridge Military Hospital she was deeply cyanosed but breathing spontaneously. Her blood pressure was 160/70, heart rate 130 beats per minute sinus rhythm. Auscultation of the chest revealed numerous high pitched rhonchi. She was given high flow oxygen by mask, intravenous aminophylline 250 mg, intravenous hydrocortisone 100mg and salbutamol by nebulizer with good effect. Her chest x-ray showed overinflated lungfields but was otherwise unremarkable. After initial resuscitation her arterial P02 was 70.8 mm of mercury. She was then transferred to the intensive care unit and given aminophylline by mouth, salbutamol by nebulizer and hydrocortisone intravenously lOOmg 4 hourly. Improvement was rapid and by the next day her peak flow was 340L/min rising to 490L/min after salbutamol. The intravenous hydrocortisone was discontinued and prednisolone 40mg daily by mouth commenced. The latter was withdrawn gradually over the following week. She was discharged on Intal, Ventolin, Becotide inhalers the latter being subsequently withdrawn. Her current therapy is regular Intal and occasional Ventolin. While in hospital two challenge tests were carried out in an attempt to determine the mechanism of the acute attack. Both tests were carried out while she was still taking oral prednisolone 20mg daily. The first test comprised eating partially thawed ice cream of the same type and flavour as that which caused initial symptoms. Her peak flow fell from 510L/min to 440L/min. The next day she was given a quantity of crushed ice to swallow. Within ten to fifteen minutes her peak flow had fallen from 500L/ min to 200L/min and this was associated with the appearance of distressing wheezy dyspnoea. A second ice stress test was carried out subsequently when her only therapy was Intal. The results are shown in Table 1. It can be seen that there was a rapid and progressive fall in FEV, over a period of 15 minutes associated with subjective dyspnoea and wheeze. The bronchospasm was rapidly reversed by inhaled salbutamol.