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Lack of efficacy: case report A 20-year-old woman experienced lack of efficacy during treatment with cetirizine, epinephrine and salbutamol for anaphylaxis. The woman, who had a history of allergic reactions following consumption of cilantro, presented for an oral challenge for cilantro. As a part of the oral challenge, she ate one-eighth of a cilantro leaf and developed anaphylaxis presenting as erythema, urticaria, pruritus and lip tingling. She also developed chest tightness, diarrhoea and emesis. She was treated with two doses of IM epinephrine 0.5mg, 4 puffs of salbutamol and sublingual cetirizine 10mg [not all routes stated]. However, despite this treatment, her symptoms persisted. The woman was therefore transferred to urgent care, and sodium chloride [normal saline], methylprednisolone and ranitidine were administered. She was instructed to avoid cilantro ingestion and carry epinephrine auto-injectors with her. Wong-Pack A, et al. Anaphylaxis to cilantro during an oral food challenge. Allergy, Asthma and Clinical Immunology 16 (Suppl.): abstr. 34, Jan 2020. Available from: URL: 803514955 http://doi.org/10.1186/s13223-020-00445-x [abstract]

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Reactions 14 Nov 2020 No. 1830