Boullata Joseph I, McDonnell Patrick J, Oliva Cynthia D
School of Pharmacy, Temple University Health Sciences Center, Philadelphia, PA 19140-5101, USA.
Ann Pharmacother. 2003 Jun;37(6):832-5. doi: 10.1345/aph.1D027.
To report a case of anaphylaxis resulting from the use of a willow bark-containing dietary supplement in a patient with a history of an aspirin allergy.
A 25-year-old white woman presented to the emergency department of a community teaching hospital with anaphylaxis requiring epinephrine, diphenhydramine, methylprednisolone, and volume resuscitation to which she responded favorably. Medication history revealed that she had ingested 2 capsules of Stacker 2 (NVE Pharmaceuticals, Newton, NJ), a dietary supplement promoted for weight loss, prior to experiencing her initial symptoms. Among other active ingredients, this product contains willow bark. Of significance is that this patient also reported a history of allergy to acetylsalicylic acid. No other causes for anaphylaxis were identified. She continued to receive routine supportive care and the remaining hospital course was uncomplicated.
Dietary supplements, including herbal products, are used by many individuals who consider them to be inherently safe despite limited regulatory oversight by the Food and Drug Administration. While there may be value to specific botanical ingredients, a potential for adverse effects also exists. The popular product consumed by our patient is used for weight loss and contains willow bark, a source of salicylates. Based on the Naranjo probability scale, it is probable that this case of anaphylaxis was due to this dietary supplement.
The use of any willow bark-containing dietary supplement may present a risk of anaphylactic reaction to patients with a history of allergy to salicylates. Clinicians need to recognize the potential for adverse effects from dietary supplements.
报告1例有阿司匹林过敏史的患者因使用含柳树皮的膳食补充剂而发生过敏反应的病例。
一名25岁白人女性因过敏反应被送至社区教学医院急诊科，需使用肾上腺素、苯海拉明、甲泼尼龙并进行容量复苏，患者反应良好。用药史显示，在出现初始症状之前，她服用了2粒Stacker 2（NVE制药公司，新泽西州牛顿市），这是一种用于减肥的膳食补充剂。该产品除其他活性成分外，还含有柳树皮。重要的是，该患者还报告有乙酰水杨酸过敏史。未发现其他过敏反应原因。她继续接受常规支持治疗，住院期间其余过程无并发症。
膳食补充剂，包括草药产品，被许多人使用，他们认为这些产品本质上是安全的，尽管美国食品药品监督管理局的监管有限。虽然特定的植物成分可能有价值，但也存在不良反应的可能性。我们的患者服用的这种流行产品用于减肥，含有柳树皮，柳树皮是水杨酸盐的来源。根据Naranjo概率量表，这例过敏反应很可能是由这种膳食补充剂引起的。
对于有水杨酸盐过敏史的患者，使用任何含柳树皮的膳食补充剂都可能存在过敏反应风险。临床医生需要认识到膳食补充剂产生不良反应的可能性。
