This case demonstrates the importance of several aspects
regarding herbal self-medication and allergic reactions:
Herbal products can cause near-fatal anaphylactic
reactions. The use of herbal products is under investigation,
and the nature of weed vegetables that are commonly
consumed is being questioned. Physicians and patients
may not use common terminology; therefore, the words
used during an interview (e.g. reaction, anaphylaxis)
should be explained, so that they are understood by the
patient. The presence of previous symptomatology and
the patient’s ability to interpret them are important for
the prevention of severe reactions.
It is important to monitor herbal treatments in the practice
of alternative and complementary medicine. “Herbalists”
should have training in botany and pharmacology
in addition to a medical education, and treatments using
herbs must be carried out by experts. However this it is
often not possible. The rapid development of the “herbal”
industry and easily accessible herbal products have led to
the spread of self-medication. Sometimes these products
are used at the advice of non-herbalist physicians or under
the guidance of the seller.
In our country, due to government support and lower
health insurance costs, all citizens benefit from orthodox
medicine health care services. In such a society, alternative
medical methods are typically considered less
desirable. In a Turkish study, the rate of herbal use was
14.2% (2). However, people often use herbal products to
maintain good health rather than treating symptoms. In
addition, “herbals are always safe” is a very common opinion.
The different allergic reactions can be seen, especially
in people who are allergic to pollen, depending on the
herbal product. We treated a patient in our clinic who had
a serious reaction to an herbal substance (3). Nearly all
clinical presentation of immediate reactions such as urticaria,
conjunctivitis, asthma exacerbation, anaphylaxis
have been reported with herbals (4, 5, 6).
When herbal products are mentioned, it is usually in
the form of tablets or capsules, or uncommon plants that
are not included in routine consumption (1). However, we
often consume plants in our daily lives that are in the class
of weeds but are referred to as vegetables, as they are not
considered herbal products because they are consumed
as food. These plants, when not used for the purpose of
and in amounts of routine consumption, should be considered
in the “herbal products” category (2, 3). Such was
the event presented in this paper. The patient used parsley
regularly and in large amounts, in foods and salads, to
maintain good health. She was atopic; over time, because
of her atopic allergy, which is defined as producing a sudden
reaction to an allergen, she became allergic to parsley.
Medical history has a very important role in investigating
the etiology of anaphylaxis. However, the patients
need to understand the questions in order to obtain useful
results from the conversation. Therefore, physicians
should use terminology understood by the patients, so
that the questions, which are the means to obtaining answers,
do not block retrieval of the correct information
instead. In the presented case, while the answer to the
question “history of previous reaction to parsley” was
“No”, the answer to the question regarding a history of
any feelings associated with parsley use was “Yes”. The patient’s
feelings, hot flashes and palpitations, were evidence
of “recurrent allergic reaction to parsley”. If the patient’s
previous symptoms or previous mild reactions had been
accurately interpreted, the development of the near-fatal
anaphylactic attack might have been prevented. However,
it was not possible, due to the patient’s misinterpretation.
Moreover, the symptomatology was perceived in a completely
different way, as “seeing the benefit”, and the patient
approached anaphylaxis, step by step (1, 3, 6).
4.CONCLUSION
People will continue to use herbal products, one way or
another, and it is not possible to have herbalist physicians
available for each patient. Family physicians are especially
required to inform their patients about issues such as
herbal products, potential loss, and allergic reactions.
There are also side effects associated with herbal products,
just as with chemical drugs. “Primum non nocere”,
which is one of the general rules of medicine, is an indisputable
fact that should true for herbal applications.