Hiccups always seem to strike at the least convenient time. Maybe you’re delivering an important presentation when you feel that telltale catch in your breath. Maybe you’re watching an emotional scene in a quiet movie theater when you inadvertently let out a “hic.” Fortunately, hiccups typically don’t last long — except in the case of an elderly man who endured more than two years of incurable hiccups, according to a paper recently published in the Journal of Medical Case Reports. Read on for more information on the strange case, which was eventually linked to a rare allergic condition.
Allergic Condition Leads to Two-Year Hiccup Attack
Hiccups are caused by involuntary contractions of the diaphragm, a muscle at the base of the chest. They’re incredibly common, generally harmless, and typically very brief. However, per a case report published in the Journal of Medical Case Reports, a 93-year-old Middle Eastern male sought medical treatment for longstanding hiccups which occurred intermittently for more than two years. Doctors tried a number of medications to stop the episodes, including muscle relaxers, proton-pump inhibitors, and even chlorpromazine, an antipsychotic sometimes used for chronic hiccups. When the man was eventually hospitalized after experiencing “fatigue and refractory hiccups lasting for two weeks,” his care team changed their approach. They needed to know: What could possibly cause a years-long hiccup attack?
The Hiccup Hunt: What Caused the Attack?
After the individual was hospitalized, a blood test suggested an unusually high level of eosinophils. These white blood cells play an important role in fending off infections; however, they are also linked to allergy and asthma symptoms. The unusually high eosinophil presence prompted doctors to perform additional testing, which eventually revealed a rare but slowly increasing condition: eosinophilic esophagitis, or EoE, a chronic digestive disorder often triggered by an allergic reaction.
Doctors Decipher Allergic Reaction
Allergic reactions are frequently characterized by a rapid, severe reaction after exposure to an allergen. Think of someone with a severe peanut allergy accidentally taking a bite of a peanut butter sandwich, for example. That person would experience near-instantaneous symptoms including swelling, difficulty breathing, and hives. EoE reactions, on the other hand, can be significantly delayed. This is because EoE is caused by the accumulation of eosinophils in the esophagus as a result of an allergic trigger. As mentioned above, eosinophils play an important role in reducing infections, but the accumulation of these white blood cells can be damaging.
Left untreated, EoE symptoms can include trouble swallowing, heartburn, and food getting stuck in the esophagus. Strangely, the individual had none of these symptoms; chronic hiccups were his primary symptom. Doctors eventually hypothesized that the patient’s EoE caused cells in the esophagus to send wayward impulses to the vagal nerve, which communicates with the diaphragm, potentially causing the hiccups. They were able to effectively treat the condition with a simple topical steroid, which eliminated the man’s hiccups and reduced his eosinophil count.
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The case proves that certain allergic conditions can sometimes appear in unexpected ways. By digging into medical literature and exploring an array of potential causes for the symptoms present, the patient’s medical team was able to dramatically improve his quality of life.
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