# Macadamia Nut-Induced Anaphylactic Shock Requiring Repeated Intramuscular Adrenaline Administration in a Three-Year-Old Girl

## TL;DR

A three-year-old girl experienced severe allergic shock from macadamia nuts and needed multiple adrenaline doses for treatment.

## Contribution

The study highlights the use of a prick-by-prick test for accurate diagnosis of macadamia nut allergy.

## Key findings

- The patient required two intramuscular adrenaline doses to manage anaphylactic shock.
- Prick-by-prick skin tests and elevated IgE levels confirmed the macadamia nut allergy.
- Vigilant blood pressure monitoring is crucial for children with immediate allergic reactions to macadamia nuts.

## Abstract

Cases of macadamia nut-induced anaphylactic shock have been rarely reported. We report the case of a three-year-old girl with anaphylactic shock who presented with generalized erythema two hours after ingesting macadamia nuts. She required two doses of intramuscular adrenaline for the treatment of anaphylactic shock. The diagnosis of macadamia nut allergy was confirmed by a prick-by-prick skin test using roasted and raw macadamia nut paste extracts and elevated serum macadamia nut-specific immunoglobulin E (IgE) levels. Appropriately using a prick-by-prick test may contribute to accurately diagnosing macadamia nut allergy, thus preventing the unnecessary avoidance of other nuts. Considering the potential for severe shock induced by macadamia nut allergy, vigilant monitoring of blood pressure changes is imperative in children presenting with immediate-type allergic reactions, such as vomiting and skin symptoms, following macadamia nut ingestion.