Upper airway edema resulting from use of Ecballium elaterium

Objectives. To present a rare occurrence in ear, nose and throat practice o f upper airway allergic edema from use of juice extracted from the fruit of Ecballium elaterium. Introduction: Ecballium elaterium is a plant indigeno us to the Mediterranean region that bears the common name squirting cucumbe r. Many people in this region for the treatment of sinusitis use the juice of its fruit. However, allergy-prone patients after using it may sometimes present with edema at various sites of the upper respiratory tract. Otolary ngologists are frequently asked to diagnose and treat such an emergency sit uation. Study Design: Retrospective review of the records of 42 patients wi th this condition during the last 4 years. Methods. Patient records were re trospectively reviewed for age, sex, presenting symptoms, physical examinat ion, and medical treatment. Seasonal distribution and data from the history of the patients were also considered. Skin prick and prick-to-prick testin g to various allergens was performed in 12 patients. Results. Most of the p atients presented with localized swelling of the uvula and the nasal mucosa , whereas in the remainder of the patients various sites of swelling of the upper respiratory tract were observed. Skin tests elicited positive reacti ons to pollen weeds and to various fruits of the Cucurbitaceae family. Trea tment of the patients with corticosteroids and antihistamines resulted in a n uneventful recovery, and we did not need to resort to therapeutic modalit ies, such as intubation or tracheotomy. Conclusions. We think a further stu dy of the pharmaceutical properties of the plant's fruit juice is needed, e specially regarding its curative properties of rhinitis and sinusitis. Howe ver, adverse reactions in some patients with a positive history of allergy should always be considered.