Published online Mar 6, 2019. doi: 10.12998/wjcc.v7.i5.623
Peer-review started: December 20, 2018
First decision: January 19, 2019
Revised: February 3, 2019
Accepted: February 18, 2019
Article in press: February 18, 2019
Published online: March 6, 2019
The practice of Indian Ayurvedic medicine is spreading in Western countries and Shilajit is one of the most used drugs, for its antioxidant activities and immunomodulatory effects. Albeit Shilajit has showed a high degree of safety, it can act as cofactor of anaphylaxis, especially in condition at high risk, such as mast cell activation syndrome (MCAS). We reported this case to sensitize practitioners to investigate to the use of complementary and alternative medicine, in case of exercise-induced anaphylaxis (EIAn).
A 43-year-old woman, working as a dance teacher, developed urticaria after ingestion of rice, tuna and Shilajit, which did not respond to intramuscular corticosteroids. Subsequently, she developed dyspnoea and hypotension with loss of consciousness that arose 1 h after sexual activity. The patient did not refer personal history of atopy. Specific IgE for main food allergens resulted negative, with total IgE levels of 14 IU/L. Oral provocation test with Shilajit was not perfomed because the patient refused, but we performed prick-by-prick and patch test that resulted negative. Serum tryptase at the time of anaphylaxis was 20.6 μg/L that fell down to of 10.6 μg/L after therapy, but has remained at the high value after two days and during the follow-up. We performed an analysis of the c-KIT gene in peripheral blood, which was negative. We felt the diagnosis consistent with EIAn in a patient with a possible MCAS.
In Western countries the use of drugs from Ayurvedic medicine is more common than in the past. These substances can be cofactors of anaphylaxis in patients with risk factors.
Core tip: This case report describes, for the first time, the role of drugs belonging to complementary and alternative medicine (CAM) in triggering anaphylaxis. Owing to the increase in their consumption in Western countries, these drugs should be considered as potential cofactor in conditions with a high risk of anaphylaxis, such as exercise-induced anaphylaxis and mast cell activation syndrome. This experience may be useful to give insight to practitioners about CAM and potential adverse drug reactions.