A Cases of Near-fatal Anaphylaxis: Parsley “Over-use” as an Herbal Remedy
Med Arh. 2014 Dec; 68(6): 426-427 427
The patient was asked again about previous allergic re-
actions, and her response was the same (i.e. she had not
previously experienced any allergic reaction to parsley).
Then, the question regarding history of the reaction was
asked in different words, as the patient was not familiar
with “allergy terminology”. The patient was asked, “Did
you ever feel anything after eating parsley?” This time, the
answer was, “Yes, I was feeling mild hot flashes and pal-
pitations” over the last few months. These statements are
consistent with flushing and tachycardia, and the system-
ic allergic reaction indicated sensitivity to an allergen. The
patient had interpreted the body’s reactions as signifying
that the parsley was providing benefits to “maintain good
health”. Rather than worrying about or being suspicious of
the reaction, she was satisfied that she was “seeing bene-
fits” of eating parsley.
3. DISCUSSION
This case demonstrates the importance of several as-
pects regarding herbal self-medication and allergic reac-
tions: Herbal products can cause near-fatal anaphylactic
reactions. The use of herbal products is under investiga-
tion, and the nature of weed vegetables that are common-
ly 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 prac-
tice of alternative and complementary medicine. “Herb-
alists” 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 un-
der the guidance of the seller.
In our country, due to government support and lower
health insurance costs, all citizens benefit from ortho-
dox medicine health care services. In such a society, al-
ternative 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 opin-
ion. The different allergic reactions can be seen, especial-
ly 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 ur-
ticaria, 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 con-
sidered in the “herbal products” category (2, 3). Such was
the event presented in this paper. The patient used pars-
ley 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 sud-
den reaction to an allergen, she became allergic to parsley.
Medical history has a very important role in investi-
gating the etiology of anaphylaxis. However, the patients
need to understand the questions in order to obtain use-
ful results from the conversation. Therefore, physicians
should use terminology understood by the patients, so
that the questions, which are the means to obtaining an-
swers, 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 pa-
tient’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 com-
pletely different way, as “seeing the bene