Pregnancy complicated by cardiac valvular disease and hypertension.

stance. Unfortunately, identification of the responsible agent is not as straightforward as it appears. We report here a case we encountered recently. A &yearold woman with a long history of reactive airway disease and peanut and soy allergies was admitted for treatment of an anaphylactic reaction after inadvertently ingesting peanut oil at a party. Her initial systemic reaction was treated successfully with subcutaneous epinephrine, corticosteroids, $-agonists, and antihistamines. At 3 h and 6 h following admission, the patient suffered two recurrences of airway obstruction, hypotension, and generalized cutaneous eruption. Both of these recurrences happened while she was receiving inhalation therapy with ipratropium bromide (Atrovent) by metereddose inhaler. After investigation, we found the drug to contain soya lecithin as one of its "inert" ingredients. We discontinued its use, which resulted in complete resolution of the patient's symptoms. There were no further recurrences. Drug-induced anaphylaxis poses a significant threat because it is unexpected, sudden, and potentially !ethal. One should consider that causes of anaphylaxis may include hidden "inert" additive ingredients in commonly prescribed drugs Specifically, clinicians treating soy-allergic patients should be cognizant of the potential for severe systemic allergic reactions with ipratropium bromide therapy.