title: Psyllium-associated anaphylaxis and death: a case report and review of the literature.
abstract: BACKGROUND
  Psyllium use has increased significantly in the United States in part due to its lipid-lowering property. The increased prevalence of consumption has led to its recognition as an emerging food allergen.
  
  
  OBJECTIVE
  To report the case of a 42-year-old woman who experienced fatal anaphylaxis after ingesting a psyllium-based product and to review the literature.
  
  
  METHODS
  The MEDLINE database was searched for articles from 1966 to 2002 using the keywords psyllium or ispaghula and each of the following: allergy, hypersensitivity, anaphylaxis, and asthma. Both English and non-English articles were included.
  
  
  RESULTS
  Psyllium hypersensitivity has been well described in health care workers and pharmaceutical plant employees. Clinical manifestations of allergy range from upper respiratory tract symptoms on inhalation to anaphylaxis on ingestion. The prevalence of sensitization varies between these 2 groups. The allergenic epitope is not known.
  
  
  CONCLUSIONS
  We present a case of psyllium hypersensitivity that resulted in death. There is a clear association between atopy and psyllium allergy. The case underscores the fact that even nonprescription "natural" products can be harmful to people with allergies.
authors.affiliation: Oregon Health & Sciences University, Portland, Oregon 97239, USA. khalilib@ohsu.edu
authors.forename: Barzin
authors.initials: B
authors.lastname: Khalili
authors.forename: Emil J
authors.initials: EJ
authors.lastname: Bardana
authors.forename: John W
authors.initials: JW
authors.lastname: Yunginger
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000139:chemically induced / Q000401:mortality; D000707:Anaphylaxis / Q000139:chemically induced* / Q000401:mortality*; D000918:Antibody Specificity / Q000187:drug effects; D002400:Cathartics / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000209:etiology / Q000401:mortality; D005260:Female; D006282:Health Personnel; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000187:drug effects; D007819:Laryngeal Edema / Q000139:chemically induced / Q000401:mortality; D009784:Occupational Diseases / Q000139:chemically induced / Q000401:mortality; D011620:Psyllium / Q000009:adverse effects*; D012697:Serine Endopeptidases / Q000097:blood / Q000187:drug effects; D053802:Tryptases
chemical_list: D002400:Cathartics; D007073:Immunoglobulin E; D011620:Psyllium; D012697:Serine Endopeptidases; D053802:Tryptases