心身医学的アプローチが有効であった身体表現性障害を合併した食物アレルギーの1例

<p>Food allergy presents a variety of symptoms, which may be difficult to improve unless psychological factors are considered in combination with apparent somatoform conditions. We report a case of severe and prolonged food allergy for which only the somatoform symptoms had been examined. The patient was a woman in her 40's. Before we examined her, she had developed various somatoform symptoms and disabilities. Finally, she has much improved by psychosomatic intervention. The patient had developed rash, abdominal distention, weakness of limbs, emotional instability, and hallucination following ingestion of some specific food items. She had been experiencing these symptoms for two years and visited several clinics, where she was diagnosed as having food allergy. She was advised to avoid all cereal grains and fruits; however, her symptoms had persisted. When she visited the allergy department at our hospital for detailed examination, she fell down from weakness of limbs, which resulted in her emergency hospitalization. Physical and clinical examinations revealed that while she had antibodies against several specific food-driven antigens, there were no detectable factors contributing to other symptoms such as neuropsychiatric abnormalities. We suspected that she had somatoform symptoms and started behavioral therapies using restriction of movement, provided guidance for coping with emotional instability and its physical response, and trained her for assertion. These treatments enabled her to control the somatoform symptoms by herself, improved food allergy, and recovered well enough to reintegrate into the society. This case implicates that food allergy patients with multifaceted symptoms may be more effectively treated if the presence of stressor and the existence of somatoform disorder are recognized early enough through psychosomatic intervention.</p>