Life-threatening uvular angioedema caused by Ecbalium Elaterium

Abstract

Ecbalium elaterium, known as the wild or squirting cucumber, is a hairy perennial herbaceous vine of the Cucurbitaceae family, endemic to the Mediterranean region. All parts of the plant are toxic, particularly the gherkin-like fruits. It is frequently used in the treatment of sinusitis by nasal aspiration in some parts of the Mediterranean. The studies regarding to Ecbalium elaterium, argue that it has an anti-inflammatory characteristic. Two cases of uvular oedema have been ascribed to the undiluted use of this substance. Since they can threaten life, similar cases arising with the improper use of herbals should not be ignored in the emergency department. In this paper we present a life-threatening uvular angioedema caused by nasal aspiration of undiluted juice of squirting cucumber.

Ethnopharmacological survey of medicinal plants used in traditional medicine by the communities of Mount Hermon, Lebanon

“…The fruit juice of Ecballium elaterium (Cucurbitacae) contains cucubitacins and elatericins and can be a dangerous purgative (Bruneton, 1999). Cases of a life-threatening uvular angioedema have been ascribed to the undiluted use of the juice (Satar et al, 2001). Externally, it can cause severe skin irritation with inflammation and edema (Plouvier et al, 1981).…”

Effect of ethanolic extract of Ecballium elaterium against Staphylococcus aureus and Candida albicans

“…Several toxicity and allergic reactions have been described if used undiluted [4,7,[13][14][15][16] . The mechanism of toxicity (i.e., direct toxic effect, hypersensitivity response) is also not well defined, but the clinical effects often do not respond to antihistamines or epinephrine.…”

Enlarged uvula (Quincke’s Oedema) – A side effect of inhaled cocaine? – A case study and review of the literature

“…Although the causative antigen is often not isolated Angiotensin-Converting Enzyme Inhibitors (ACEi) are widely reported to cause angioedema of the uvula (Wong et al, 2000;Kuo and Barish, 1995). Another reported allergen known to cause angioedema of the uvula is the juice of the wild or squirting cucumber -Ecballium elaterium -an herbaceous vine grown in the Mediterranean and used as an homeopathic remedy for sinusitis (Huang, 2007;Satar et al, 2001).…”