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Keywords:

  • anaphylaxis;
  • boldo;
  • SDS-PAGE;
  • immunoblot

Boldo (Peumus boldus) is a Monimiaceae family tree, native of the Andean regions used in natural medicine as a traditional herbal remedy because of its choleretic, cholagogue, diuretic, antipyretic, anti-inflammatory, anthelmintic and hypnotic properties.

We report a case of an anaphylactic reaction (1) after the intake of a boldo infusion. A 30-year-old man with a personal history of allergic rhinoconjunctivitis because of hypersensitivity to grass pollen was attended for an immediate episode of an acute and generalized urticaria, facial angioedema, dysphagia, dysphonia and dyspnea after the intake of a boldo infusion. He required an emergency treatment with subcutaneous adrenaline, parenteral antihistamines and corticosteroids.

Skin prick tests to common aeroallergens were positive to Phleum (8 mm wheal diameter) and Cynodon (7 mm wheal diameter) with a positive control wheal for histamine of 6 mm. Skin prick test with boldo infusion was negative. Oral administration started with one little spoon; the dose was doubled and at the end the intake to approximately 250 ml. The patient presented a good tolerance initially but 30 min after 250 ml of a boldo infusion, he showed an immediate response with pharyngeal pruritus, hives on neck and thorax and dysphonia, been treated with subcutaneous adrenaline.

We obtained a boldo extract after dialyzing against twice-distilled water, a concentration of 4 g of boldo in phosphate-buffered saline (PBS) 1 : 25 (w/v) for 24 h. It was then sterile-filtered and concentrated by centrifugation. The protein content measured by the Lowry–Biuret method was 15,6 mg/ml. SDS-PAGE as described by Laemmli was used to determine the antigenic profile, showing several proteins with a high molecular weight (Fig. 1). The gel was electrophoretically transferred to a nitrocellulose membrane (BIO-RAD®, Hercules, CA) and an indirect enzyme immunoassay was performed by incubating for 1 h and after washing with our patient sera, IgG against human IgE and human IgG peroxidase, respectively, obtaining defined bands of 115, 150 and 199 kDa (Fig. 1). The immunoblot with 10 random-selected control patients serum was negative.

image

Figure 1. A, SDS-PAGE, silver stain, lane 1 molecular weights, lane 2 boldo extract; B, specific-IgE immunoblot, lane 1 boldo extract; C, negative controls.

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In conclusion, the positive oral challenge and the finding of bands in the immunoblotting suggest a type I IgE-mediated immunologic mechanism as being responsible for the patient's anaphylactic symptoms. It has been described that IgE symptoms with other infusions like coffee (2), cacao (3), tea (4) and chamomile tea (5) causes urticaria, occupational asthma and anaphylaxis respectively, but we have not found any case described in the literature with boldo.

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