Human Exposure to Ecballium elaterium Fruit Juice: Fatal Toxicity and Possible Remedy

Abdulazim S. Salhab

Department of Pharmacology University of Jordan, Amman, Jordan..

DOI: 10.4236/pp.2013.45064                

Abstract

The human serious adverse reactions of the folkloric plant, Ecballium elaterium (EE), are well documented in the literature. This report is presenting the medical literature of 74 cases, which experienced severe adverse reactions or deaths that resulted from the administration of the plant juice. The survey of these human cases exhibits several adverse effects such as: acute rhinitis, uvular edema, soft palate, upper airway edema. In conclusion, the use of EE juice in folk medicine can cause severe adverse reactions that should not be ignored but it should be medically treated.

Keywords

Ecballium elaterium; Cucurbitacine; Uvular Edema; Sinusitis; Rhinitis, Conjunctivitis; Angioedema; Soft Palate; Hypoxemia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	B. Abu-Irmeileh, “Weeds of Jordan (Book),” Publication of the University of Jordan, Amman, 1982.
[2]	J. Jabour, “Al-kannon in Medicine of Avicenna (Book),” Al-Ma’ref Library, Beirut, 1983.
[3]	E. A. Mazokopakis, C. M. Karefilakis and I. K. Starakis, “The Safety and Efficacy of the Fruit Juice of Ecballium elaterium in the Treatment of Acute Rhinosinusitis,” The Journal of Alternative and Complementary Medicine, Vol. 15, No. 2, 2009, pp. 1273-1274. doi:10.1089/acm.2009.0241
[4]	G. Worall, “Acute Sinusitis,” Canadian Family Physician, Vol. 54, 2008, pp. 82-83
[5]	E. Cezik and E. Yesilada, “Clincal Effects of the Juice of Ecbalium elaterium in the Treatment of Sinusitis,” Clinical Toxicology, Vol. 33, No. 4, 1995, pp. 381-383. doi:10.3109/15563659509028931
[6]	E. Yesilada, S. Tanaka, E. Sezik and M. Tabata, “Isolation of Anti-Inflammatory Principle from the Fruit Juice of Ecballium elaterium,” Journal of Natural Products, Vol. 51, No. 3, 1988, pp. 504-508. doi:10.1021/np50057a008
[7]	H. Greige-Gerges, R. A. Khalil, E. A. Mansour, J. Magdalou, R. Chahine and N. Quaini, “Cucurbitacins from Ecballium elaterium Juice Increase the Binding of Bilirubin and Ibuprofen to Albumin in Human Plasma,” Chemico-Biological Interactions, Vol. 169, No. 1, 2007, pp. 53-62. doi:10.1016/j.cbi.2007.05.003
[8]	A. S. Salhab, H. H. Elayan, M. N. Ghraibeh and S. Amer, “The Acute Toxicity of the Juice of Ecballium elaterium Rich,” Dirasat, Vol. 8, No. 11, 1986, pp. 91-99.
[9]	D. Lavi and D. Willner, “The Constituent of Ecballium elatrrium L. III. Elatrecein A and B,” Journal of the American Society, Vol. 80, No. 3, 1985, pp. 710-714. doi:10.1021/ja01536a047
[10]	J. L. Hartwell, “Types of Anticancer Agents Isolated from Plants,” Cancer Treatment Report, Vol. 60, No. 8, 1976, pp. 1031-1067.
[11]	G. A. Cordell and N. R. Fransworth, “Expermental Antitumer Agents,” Journal of Natural Products, Vol. 40, No. 60, 1977, pp. 1-66.
[12]	G. Kloutsos, D. G. Balatsouras, A. C. Kaberos, et al., “Upper Airway Edema Resulting from Use of Ecbalium elaterium,” Laryngoscope, Vol. 111, No. 9, 2001, pp. 1652-1655. doi:10.1097/00005537-200109000-00030
[13]	I. Kocak, Y. Kaabela, M. Karaman and F. Kaya, “Latee Lamellar Keratitis as a Result of the Toxic Effects of Ecballium elaterium Herb,” Journal of Refractive Surgery, Vol. 22, No. 8, 2006, pp. 826-827.
[14]	S. Satar, Y. Gokel, N. Toprak and A. Sebe, “Life-Threatening Uvular Angioedema Caused by Ecbalilium elaterium,” European Journal of Emergency Medicine, Vol. 8, No. 4, 2001, pp. 337-339. doi:10.1097/00063110-200112000-00018
[15]	B. Raiklin-Eisenkraft and Y. Bentur, “Ecballium elaterium (Squirting Cucumber): Remedy or Poison?” Clinical Toxicology, Vol. 38, No. 3, 2000, pp. 305-308. doi:10.1081/CLT-100100936
[16]	I. Kokkonouzis, G. Antonio, S. Varvaressos, G. Konstantopoulos, V. Ntouli, P. Vergou and V. Myidaki, “Upper Airway Edema Due to Nasal Aspiration of Undiluet Juice of Ecballium elaterium: Report of Three Cases,” American Journal of Case Reports, Vol. 9, 2008, pp. 255-258.
[17]	G. A. Koussidis, S. Mountantonakis and C. C. Petrichou, “Folk Remedies Still in Use, a Case of Soft Palate Uvular Edema Due to Ecballium,” International Journal of Clinical Practice, Vol. 56, No. 10, 2002, p. 817.
[18]	O. Eray, Y. Tuncok, E. Eray, A. Gunerli and H Guven, “Severe Uvular Angioedema Caused by Intranasal Administration of Ecballium elaterium,” Veterinary and Human Toxicology, Vol. 41, No. 6, 1999, pp. 376-378.
[19]	P. Apostolos, P. Athanasios, G. Georgios, S. Charalambos, L. Emmanouil, D. Loannis, C. Loannis, K. Anastasia and A. Georgios, “Severe Uvular Edema and Resulting Hypoxemia Due to Single Use of Ecballium elaterium Extract,” American Journal, Vol. 13, 2012, pp. 11-13.
[20]	P. Vlachos, N. N. Kanitsakis and N. Konsas, “Fatal Cardiac and Renal Failure Due to Ecballium elaterium (Squirting Cucumber),” Clinical Toxicology, Vol. 32, No. 6, 1994, pp. 737-738. doi:10.3109/15563659409017981
[21]	K. Aydogan, S. Yazici and H. Turan, “A Rare Reason for Uvular Angioedema: Ecballium elaterium,” Annals of Dermatology, Vol. 24, No. 3, 2012, pp. 358-359. doi:10.5021/ad.2012.24.3.358
[22]	C. Eken, K. Ozbek, C. K. Yildirim and O. Eray, “Severe Uvular Edema and Nasal Muosal Necrosis Due to Ecballium elaterium (Squirting Cucumber): An Allergic Reaction or Direct Toxic Effect?” Clinical Toxicology, Vol. 46, No. 3, 2008, pp. 257-258. doi:10.1080/15563650601158834
[23]	P. A. Dennery, D. S. Seidman and D. K. Stevenson, “Neonatal Hyperbilirubinnemia,” The New England Journal of Medicine, Vol. 344, 2001, pp. 581-590. doi:10.1056/NEJM200102223440807
[24]	P. A. Dennery, “Pharmacological Intervention for the Treatment of Neonatal Jaundice,” Seminars in Neonatology, Vol. 7, No. 2, 2002, pp. 111-119. doi:10.1053/siny.2002.0098
[25]	W. Huang, J. Zhang and D. D. Moore, “A Traditional Herbal Medicine Enhances Bilirubin Clearance by Activating the Nuclear Receptor,” The Journal of Clinical Investigation, Vol. 113, No. 1, 2004, pp. 137-143.
[26]	J. Yin, M. Miller and R. P. Wennberg, “Induction of Hypatic Bilirubin Metabolizing Enzymes by the Traditional Chinese Medicine Yin Zhi Hung,” Developmental Pharmacology and Therapeutics, Vol. 16. No. 3, 1991, pp. 176-184.
[27]	H. H. Elayan, M. N. Gharaibeh, S. M. Zmmeili and A. S. Salhab, “Effects of Ecballium elaterium Juice on Serum Bilirubin Concentration in Male Rats,” International Journal of Crude Drug Research, Vol. 27, 1984, pp. 227-238.