{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:44:54Z","timestamp":1773276294188,"version":"3.50.1"},"reference-count":16,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,2,21]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>Inducible laryngeal obstruction (ILO) is an under-recognised cause of refractory breathlessness. It presents with an acute onset of difficulty in breathing and is often mistaken for respiratory conditions such as asthma or, in some cases, anaphylaxis. People with ILO often report recurrent Accident &amp; Emergency attendances and have long-term drug treatments initiated and escalated inappropriately. The cornerstone of ILO management is speech and language therapy, and it is essential that cases are identified promptly to ensure they are managed correctly. By doing this, patients can be supported with education and therapeutic strategies, thus reducing associated distress, unnecessary pharmacotherapy and overall healthcare utilisation. In this case study, we describe a patient who was diagnosed and successfully treated for ILO after initially being investigated for recurrent anaphylaxis. She had a significant symptom burden with multiple hospital admissions and relied on epinephrine to manage these episodes. Following specialist assessment and treatment, she was subsequently weaned off potentially dangerous medications that were not clinically indicated, while reporting a marked improvement in her quality of life (see Patient\u2019s perspective below).<\/jats:p>","DOI":"10.1136\/bcr-2024-264236","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T13:45:21Z","timestamp":1741355121000},"page":"e264236","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Anaphylaxis versus inducible laryngeal obstruction: a diagnostic dilemma"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8936-3204","authenticated-orcid":false,"given":"Bethany","family":"Tidmarsh","sequence":"first","affiliation":[{"name":"Asthma & Airways Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siobhan","family":"Ludlow","sequence":"additional","affiliation":[{"name":"Asthma & Airways Service, Manchester University NHS Foundation Trust, Manchester, UK"},{"name":"Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Fowler","sequence":"additional","affiliation":[{"name":"Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK"},{"name":"Manchester Biomedical Research Centre, NIHR, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"key":"2025082804135588000_18.3.e264236.1","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1111\/cea.13745","article-title":"UK consensus statement on the diagnosis of inducible laryngeal obstruction in light of the COVID-19 pandemic","volume":"50","author":"Haines","year":"2020","journal-title":"Clin Exp Allergy"},{"key":"2025082804135588000_18.3.e264236.2","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1016\/j.jaip.2022.02.025","article-title":"Vocal cord dysfunction\/inducible laryngeal obstruction(s) mimicking anaphylaxis during SARS-CoV-2 (COVID-19) vaccination","volume":"10","author":"Leong","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025082804135588000_18.3.e264236.3","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.jaip.2021.11.008","article-title":"Differentiating Throat Symptoms in Inducible Laryngeal Obstruction From Anaphylaxis-Information for Patients and Health Care Professionals","volume":"10","author":"Tidmarsh","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025082804135588000_18.3.e264236.4","unstructured":"Asthma + Lung UK . What is asthma? Available: https:\/\/www.asthmaandlung.org.uk\/conditions\/asthma\/what-asthma [Accessed 31 Oct 2024]."},{"key":"2025082804135588000_18.3.e264236.5","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1111\/cea.13185","article-title":"Diagnosis of concomitant inducible laryngeal obstruction and asthma","volume":"48","author":"Lee","year":"2018","journal-title":"Clin Exp Allergy"},{"key":"2025082804135588000_18.3.e264236.6","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201010-1604OC"},{"key":"2025082804135588000_18.3.e264236.7","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1016\/j.jaip.2024.01.030","article-title":"Clinical Characteristics and Impact of Inducible Laryngeal Obstruction in the UK National Registry","volume":"12","author":"Haines","year":"2024","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025082804135588000_18.3.e264236.8","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1080\/17476348.2023.2215434","article-title":"Vocal cord dysfunction\/inducible laryngeal obstruction: novel diagnostics and therapeutics","volume":"17","author":"Koh","year":"2023","journal-title":"Expert Rev Respir Med"},{"key":"2025082804135588000_18.3.e264236.9","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.jaip.2021.10.017","article-title":"The Impact of Functional Laryngoscopy on the Diagnosis of Laryngeal Hypersensitivity Syndromes","volume":"10","author":"Vertigan","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025082804135588000_18.3.e264236.10","doi-asserted-by":"crossref","first-page":"2605","DOI":"10.1016\/j.vaccine.2022.11.027","article-title":"Anaphylaxis: Revision of the Brighton collaboration case definition","volume":"41","author":"Gold","year":"2023","journal-title":"Vaccine (Auckl)"},{"key":"2025082804135588000_18.3.e264236.11","article-title":"Recognizing Vocal Cord Dysfunction: Exercising Caution Before Intubation","volume":"15","author":"Fernandes","year":"2023","journal-title":"Cureus"},{"key":"2025082804135588000_18.3.e264236.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2023.06.007"},{"key":"2025082804135588000_18.3.e264236.13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41572-022-00370-w","article-title":"Cough hypersensitivity and chronic cough","volume":"8","author":"Chung","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2025082804135588000_18.3.e264236.14","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1111\/cea.14156","article-title":"Laryngoscopy diagnosis of inducible laryngeal obstruction during supervised challenge for suspected anaphylaxis","volume":"52","author":"Stojanovic","year":"2022","journal-title":"Clin Exp Allergy"},{"key":"2025082804135588000_18.3.e264236.15","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/cea.14036","article-title":"Treatment effectiveness for Vocal Cord Dysfunction in adults and adolescents: A systematic review","volume":"52","author":"Mahoney","year":"2022","journal-title":"Clin Exp Allergy"},{"key":"2025082804135588000_18.3.e264236.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-032877","article-title":"Severe Asthma Toolkit: an online resource for multidisciplinary health professionals-needs assessment, development process and user analytics with survey feedback","volume":"10","author":"Maltby","year":"2020","journal-title":"BMJ Open"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264236","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:14:05Z","timestamp":1756379645000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,7]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bcr-2024-264236"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264236","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}