Fuente: PubMed "hive" J Allergy Clin Immunol Pract. 2026 Feb 11:S2213-2198(26)00138-8. doi: 10.1016/j.jaip.2026.02.006. Online ahead of print.ABSTRACTBACKGROUND: Vocal cord dysfunction (VCD), or inducible laryngeal obstruction (ILO), is an episodic upper airway disorder that can mimic anaphylaxis.OBJECTIVE: To determine the prevalence of VCD/ILO among adults referred to allergy clinic for suspected anaphylaxis and to identify clinical markers that distinguish VCD/ILO from anaphylaxis.METHODS: We conducted a retrospective study of adults referred for suspected anaphylaxis to a tertiary allergy clinic in Newcastle, Australia, in 2023. Patients were classified as confirmed VCD/ILO (laryngoscopy-proven), suspected VCD/ILO (spirometry findings or high clinical suspicion after exclusion of alternate diagnoses), anaphylaxis, or other. Demographics, triggers, comorbidities, clinical features, investigations, and healthcare utilisation were compared between laryngoscopy-confirmed VCD/ILO and anaphylaxis.RESULTS: Among 133 adults, 11 (8.3%) had laryngoscopy-confirmed VCD/ILO. Inclusion of suspected cases (n = 21, 15.8%) increased prevalence of VCD/ILO to 24.1% (n = 32). Compared with anaphylaxis, VCD/ILO was characterised by predominant upper airway symptoms, including throat tightness (100% vs 53.8%, p = 0.004), stridor (36.4% vs 1.9%, p = 0.003), dysphonia (72.7% vs 17.3%, p < 0.001), and cough (54.5% vs 1.9%, p < 0.001) with fewer systemic symptoms (urticaria 18.2% vs 84.6%, p < 0.001; gastrointestinal 9.1% vs 44.2%, p = 0.04; cardiovascular 0% vs 55.8%, p < 0.01). Multiple triggers were more common in VCD/ILO (72.7% vs 1.9%, p < 0.001), particularly aerosolised chemicals (36.4% vs 0%, p < 0.001). IgE sensitisation to the proposed trigger was uncommon (9.1% vs 63.5%, p < 0.008) in VCD/ILO.CONCLUSION: VCD/ILO is a frequent differential diagnosis in adults referred for anaphylaxis. Recognition of its characteristic clinical features and trigger profiles may prevent misdiagnosis, reduce healthcare utilisation, and improve patient outcomes.PMID:41687869 | DOI:10.1016/j.jaip.2026.02.006