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Psyllium Research

Many common products utilize Psyllium with the intention of providing constipation relief, lowering cholesterol, or even promoting weight loss. However, potential side effects and especially negative health consequences of this herbal substance often go unreported. The journal abstracts below describe a variety of serious allergic reactions and digestive conditions from ingesting Psyllium in even minute amounts. Despite the claims of many manufacturers, use of laxatives or constipation relievers containing Psyllium (or its components or extracts), or ingestion of this “natural” herbal supplement can be a potentially fatal decision. A recent search on Shopping.com with the keyword “Psyllium” revealed over 800 products and variants containing this ingredient. Although most of these herbal supplements offer direct-to-consumer sales options, many can be found on shelves of your neighborhood grocery store or pharmaceutical outlet under brand names. Psyllium has even been included in breakfast cereal marketed at reducing cholesterol by being “heart healthy.” Nonetheless, as you may believe you are consuming a “natural” substance, you may likewise consider giving it to your child when they are constipated. After all, if it’s included in breakfast cereal there can’t be anything unsafe about it right? These products’ manufacturers must also believe in the risk of using Psyllium, as they include warnings on the labels similar to this one (chosen randomly): “Warnings

  • Taking this product without adequate fluid may cause it to swell and block your throat or esophagus and may cause choking.
  • Do not take this product if you have difficulty in swallowing.
  • If you experience chest pain, vomiting or difficulty in swallowing or breathing after taking this product seek immediate medical attention.
Allergy Alert: This product may cause an allergic reaction in people sensitive to inhaled or ingested Psyllium.
Ask a doctor before use if you have:
  • A sudden change in bowel habits persisting for 2 weeks
  • Abdominal pain, nausea or vomiting
Stop use and ask a doctor if: Constipation lasts more than 7 days or rectal bleeding occurs. These may be signs of a serious condition.
  • Keep out of reach of children.
  • In case of overdose, get medical help or contact a Poison Control Center right away.”

Do any of those side effects sound like appealing “benefits” of a product that’s supposed to help you? You may not understand the scientific process involved in an empirical study or even many of the medical terms and mathematics included in these reports, but the results should be self-evident. Please read these abstracts as a starting point, and then conduct your own research before considering using any herbal product (such as a laxative) containing Psyllium, Senna, Cascara sagrada or any unsafe herbs. Perhaps most importantly–try to find a truly natural, organic, and especially safe supplement to assist you in alleviating digestive difficulty on your journey to achieving optimal health and wellness.


Moderation of lactulose-induced diarrhea by psyllium: effects on motility and fermentation

Summary: Psyllium may slow down the digestive process rather than make it more efficient. “Psyllium has been reported to inhibit lactulose-induced colonic mass movements and to benefit patients with irritable bowel syndrome, improving both constipation and diarrhea. Our aim was to define how psyllium modified the whole-gut transit of a radiolabeled lactulose-containing test meal by using gamma scintigraphy. Eight subjects participated in a randomized crossover study comparing gastric emptying and small bowel and colonic transit after consumption of 20 mL lactulose three times daily with or without 3.5 g psyllium three times daily. Psyllium significantly delayed gastric emptying: the time to 50% emptying increased from a control value of 69 +/- 9 to 87 +/- 11 min (mean +/- SEM; P < 0.05, n = 8). Small bowel transit was unaltered. However, progression through the colon was delayed with an increase in the percentage of the dose at 24 h in the ascending (control group: 2 +/- 3%, psyllium group: 11 +/- 8%; P < 0.02) and transverse colon (control group: 5 +/- 12%, psyllium group: 21 +/- 14%) with correspondingly less in the descending colon. Although the time for 50% of the isotope to reach the colon was not significantly different with psyllium, psyllium significantly delayed the rise in breath-hydrogen concentrations, which reached 50% of their peak at 217 +/- 34 min compared with control values of 155 +/- 27 min (P < 0.05). Psyllium delays gastric emptying, probably by increasing meal viscosity, and reduces the acceleration of colon transit, possibly by delaying the production of gaseous fermentation products.[1]

Division of Gastroenterology and Department of Surgery, Queen’s Medical Centre, Nottingham, United Kingdom. neena.washington@nottingham.ac.uk
[1] Washington, N., Harris, M., Mussellwhite, A. and R. C. Spiller. “Moderation of Lactulose-induced diarrhea by psyllium: effects of motility and fermentation.” The American Journal of Clinical Nutrition. Vol. 67, Issue 2. (317-21). Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 9459381 [PubMed - indexed for MEDLINE].

Effect of four-day psyllium supplementation on bowel preparation for colonoscopy: A prospective double blind randomized trial [ISRCTN76623768]

Summary: When cleansing the colon in preparation for a colonoscopy, Psyllium supplementation may interfere with the cleansing process. “BACKGROUND: Patients with new onset constipation or presumed hemorrhoid bleeding frequently require the use of both fiber supplements and diagnostic colonoscopy. We sought to determine whether preliminary fiber supplementation would alter the tolerability or efficacy of a standard bowel preparation for colonoscopy. METHODS: A prospective, double blind, randomized trial was designed to compare a short course of a psyllium-based supplement versus placebo prior to a colon lavage. Patients were given an unlabeled canister of powder, and instructed to take 1 tablespoon with 8 oz of water bid for 4 days before colonoscopy. A 4-liter polyethylene based glycol lavage was self-administered over 4 hours on the day prior to colonoscopy. A questionnaire on pre-study bowel habits and side effects was completed. Efficacy of the preparation was visually evaluated on a pre-determined scale. RESULTS: There were no significant differences between the two groups in gender, race, age, pre-study stool frequency or consistency. Tolerability was equivalent but efficacy of the bowel preparation was worse in the psyllium group compared to placebo (P < 0.05). CONCLUSIONS: In non-constipated patients psyllium based fiber supplementation should not be initiated in the few days prior to endoscopy using a polyethylene glycol preparation.[2]

Wayne State University, Detroit MI, John D, Dingell VAMC, Detroit, MI, USA. walter.salwen@med.va.gov
[2] Salwen, W. A. and M. D. Basson. “Effect of four-day psyllium supplementation on bowel preparation for colonoscopy: A prospective double blind randomized trial [ISRCTN76623768].” BMC Gastroenterol. Vol. 4, Issue 2. 2004 Feb 2. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PMID: 15005812 [PubMed - indexed for MEDLINE].

Psyllium-associated anaphylaxis and death: A case report and review of the literature

Summary: Many people may try Psyllium to relieve constipation or as a “weight-loss” supplement, but not realize they can experience an allergic reaction to this herb just as some people are allergic to seafood, bee stings, etc. “BACKGROUND: Psyllium use has increased significantly in the United States in part due to its lipid-lowering property. The increased prevalence of consumption has led to its recognition as an emerging food allergen. OBJECTIVES: To report the case of a 42-year-old woman who experienced fatal anaphylaxis after ingesting a psyllium-based product and to review the literature. METHODS: The MEDLINE database was searched for articles from 1966 to 2002 using the keywords psyllium or ispaghula and each of the following: allergy, hypersensitivity, anaphylaxis, and asthma. Both English and non-English articles were included. RESULTS: Psyllium hypersensitivity has been well described in health care workers and pharmaceutical plant employees. Clinical manifestations of allergy range from upper respiratory tract symptoms on inhalation to anaphylaxis on ingestion. The prevalence of sensitization varies between these 2 groups. The allergenic epitope is not known. CONCLUSIONS: We present a case of psyllium hypersensitivity that resulted in death. There is a clear association between atopy and psyllium allergy. The case underscores the fact that even nonprescription “natural” products can be harmful to people with allergies.[3]

Oregon Health & Sciences University, Portland, Oregon 97239, USA. khalilib@ohsu.edu
[3] Khalili, B., Bardana Jr., E. J. and J. W. Yunginger. . “Psyllium-associated anaphylaxis and death: A case report and review of the literature.” Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. Vol. 91, Issue 6. (579-84). Pub. 2003 Dec. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 14700444 [PubMed - indexed for MEDLINE].

Esophageal obstruction caused by dietary fiber from Plantago ovata (Psyllium), a complication preventable by adequate information]

Summary: Fiber “bulks” in the presence of water; and the granular variant of Psyllium can swell up in the esophagus or elsewhere (due to water absorption) and may restrict or block air flow. [Article in Spanish] “INTRODUCTION: Plantago ovata (PO) is widely used as a dietary fiber in the treatment of constipation. A case of esophageal obstruction due to PO is presented. Other published cases are reviewed, and possible risk factors and prevention are discussed. CASE REPORT: A 41-year-old woman felt chest pain and regurgitation immediately after swallowing a tablespoonful of PO in granules. She kept the granules in her mouth for a few seconds before swallowing them with 250 ml of water. Flexible endoscopy revealed a brown-black consistent mass blocking the inferior esophagus. A mild hiatus hernia was subsequently discovered. DISCUSSION: All the cases found through an unlimited Medline search using key words Plantago, Psyllium, mucilage, bezoars and esophagus, were taking PO in granules. Most of the cases took the granules with insufficient liquid, and some had previous obstructive esophageal disease. PO in powder probably presents a lower risk of esophageal obstruction.”[4]

Especialistas en Medicina Familiar y Comunitaria. Area 6. Madrid, Spain. olisalguero@telefonica.net
[4] Salguero, Molpeceres O., Seijas, Ruiz-Coello M. C., Hernandez, Nunez J., Caballos, Villar D., Diaz, Picazo L. and Garcia-Monzon L. Averbe. “Esophageal obstruction caused by dietary fiber from Plantago ovata (Psyllium), a complication preventable by adequate information].” Gastroenterologia y hepatologia. Vol. 26, Issue 4. (248-50) Pub. 2003 Apr. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 12681118 [PubMed - indexed for MEDLINE].

Bolus obstruction of pouch outlet by a granular bulk laxative after gastric banding

Summary: A bulking-agent (such as Psyllium fiber products) can swell up within the digestive tract and block normal function, especially in situations involving intestinal surgery such as banding.
“BACKGROUND: Constipation is an occasional problem after gastric banding and is often caused by insufficient liquid intake. As a result, the use of laxatives is widespread in such patients. Depending on the laxative, improper use can lead to bolus obstruction above the band, as occurred in this case. Case Report: A 59-year-old female with uncomplicated laparoscopic adjustable gastric banding presented 2 months after surgery with food and liquid intolerance and dysphagia after ingestion of a granular bulking laxative. Despite deflating the band, the bolus could not be washed out. Endoscopic extraction was required, revealing a 4×2 cm bolus of the laxative and a small compression ulcer. CONCLUSION: Nutritional counseling after gastric banding should include the recommendation of liquid intake of at least 1.5 l/day.” DISCUSSION: Patients not complying with nutritional recommendations after gastric banding may have insufficient liquid intake and, consequently, constipation. Under these conditions, the use of a granular bulking laxative entails the risk of esophageal obstruction above the band.”[5]
Department of Surgery, St. Claraspital, Basel, Switzerland.
[5] Herrle, F., Peters, T., Lang. C., von Fluee, M., Kern, B. and R. Peterli. “Bolus obstruction of pouch outlet by a granular bulk laxative after gastric banding.” Obesity surgery : the official journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. Vol. 14, Issue 7. (1022-4). Pub. 2004 Aug. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 15329197 [PubMed - indexed for MEDLINE].

Psyllium laxative-induced anaphylaxis, asthma, and rhinitis

Summary: Even after years of non-eventful use or exposure to Psyllium, you can develop an allergy to the herb which can potentially lead to a life-threatening reaction after ingestion.
A 69-year-old nurse was evaluated for a recent episode of anaphylaxis that had occurred after psyllium ingestion. She had experienced recurrent rhinitis and asthma related to psyllium exposure for the past 15 years. The diagnosis of psyllium hypersensitivity was established by a positive psyllium puncture skin test, an elevated psyllium-specific IgE level in serum, and a confirmatory soluble-antigen competitive inhibition test. The patient was symptomatic for several years, and this diagnosis was not considered until she suffered potentially life-threatening anaphylaxis. Psyllium hypersensitivity may be a more common phenomenon than is currently appreciated by physicians and other health-care providers.[6]
Department of Internal Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA.
[6] Vaswani, S. K., Hamilton, R. G., Valentine, M. D. and N. F. Adkinson Jr. “Psyllium laxative-induced anaphylaxis, asthma, and rhinitis.” Allergy. Vol. 51, Issue 4. (266-8). Pub. 1996 Apr. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 8792925 [PubMed - indexed for MEDLINE].

Psyllium hypersensitivity

Summary: In the attempt to increase profit, some manufacturers use parts of the Psyllium plant containing proteins capable of inducing severe allergic reactions.
BACKGROUND: Psyllium-containing laxatives are used by 4 million Americans daily. Dietary supplements for the management of hypercholesterolemia and for prevention of colon cancer make up additional uses of this plant fiber. OBJECTIVE: To assess a patient in an HMO practice with allergic cutaneous and respiratory findings associated with chronic psyllum [sic] ingestion and review information on psyllium hypersensitivity. METHODS: Clinical and laboratory evaluation of the patient and literature review through MEDLINE. RESULTS: Two years after initiating regular psyllium-containing laxative use a 40-year-old woman presented with a pruritic macular, papular, and urticarial rash involving the entire body including the palms, soles, and oropharynx sparing only the face. There was an associated sensation of chest and throat tightness and lip swelling. The signs and symptoms resolved upon discontinuance of the psyllium and recurred immediately after the patient initiated a challenge test. The total serum IgE was elevated and the modified RAST for psyllium-specific IgE was positive (Plantago ovata antigen). CONCLUSIONS: The allergens in psyllium appear to be protein in nature and derived from the inner seed endospore and embryo rather than from the husk itself. The patient described herein was sensitized and challenged via ingestion.[7]
Department of Internal Medicine, CIGNA Healthcare of Arizona, Phoenix.
[7] Freeman, G. L. “Psyllium hypersensitivity.” Annals of allergy. Vol. 73, Issue 6. (490-2). Pub. 1994 Dec. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 7998662 [PubMed - indexed for MEDLINE].

Delayed psyllium allergy in three nurses

Summary: Some people possess hyper-sensitivity to Psyllium and may not be aware of it, possibly leading to a dangerous situation when exposure occurs. “The use of psyllium has been associated with various allergic reactions. Three nurses at the Prescott Veterans Affairs Medical Center had differing degrees of psyllium allergy. The reactions ranged from sneezing to chest congestion and wheezing. Two nurses were available for skin testing, and both had a positive wheal reaction. Psyllium allergic reactions have been reported rarely in the literature; however, they may be more prevalent than previously realized.”[8]

Veterans Affairs Medical Center, Baltimore, MD 21218.
[8] Ford, M. A., Cristea Jr., G., Robbins, W. D., Gentes, G. R., Harper, S. J. and J. P. Rindone. “Delayed psyllium allergy in three nurses.” Hospital pharmacy. Vol. 27, Issue 12. (1061-2). Pub. 1992 Dec. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 10122508 [PubMed - indexed for MEDLINE].

Asthma and allergy associated with occupational exposure to Psyllium (Ispaghula) and senna products in a pharmaceutical work force

Summary: In the manufacturing process for Psyllium supplements, long-term exposure to this herb can lead to hyper-sensitivity, allergic reactions, and even asthma especially in smokers or people with diminished lung capacity. “A cross-sectional study of 125 pharmaceutical workers engaged in the manufacture of bulk laxatives based on ispaghula husks (psyllium) and senna pods was conducted. Skin prick tests with extracts of these components revealed that 7.6% were allergic to ispaghula and 15.3% were allergic to senna. Four (3.2%) cases of occupational asthma were identified. The overall prevalence of asthma (6.4%) was less than in a comparable nonexposed Australian population (odds ration, 0.44). Symptoms referable [sic] to the upper airways, eyes, and skin were more prevalent (52.0%) than in the reference population (odds ratio, 1.53). Smokers and nonatopic subjects were more likely to complain of these symptoms if they were sensitized to senna and/or ispaghula than if they were not sensitized (relative risks, 1.9 and 2.6, respectively). Sensitization to ispaghula and/or senna was not a risk factor for asthma. An IgE-mediated allergic mechanism is probably responsible for the allergic symptoms in many of these subjects. Smoking seems to be a cofactor in this process.”[9]

Institute of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
[9] Marks, G. B., Salome, C. M. and A. J. Woolcock. “Asthma and allergy associated with occupational exposure to Psyllium (Ispaghula) and senna products in a pharmaceutical work force.” The American review of respiratory disease. Vol 144, Issue 5. (1065-9). Pub. 1991 Nov. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 1952432 [PubMed - indexed for MEDLINE].

Anaphylactic reactions to a psyllium-containing cereal

Summary: Consumers may not be aware of Psyllium being included as an ingredient in common products, thus a potential exists for a severe allergic reaction, especially in individuals that have been exposed to the herb in occupational settings. “Historical data were obtained by questionnaire and telephone survey on 20 of 24 women with reported allergic reactions to a psyllium-containing cereal, Heartwise. Protein fractions from this new cereal, as well as from psyllium mucilloid and a psyllium-containing laxative, Metamucil, were extracted, quantitated, and separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Patients’ sera were collected, and specific IgE and IgG antibodies to these psyllium antigens were detected by immunoblotting techniques. Of the 20 women evaluated, all but six were nurses. Eighteen (90%) of the women had historical and/or laboratory evidence of atopy. Exposures included ingestion or dispensing of psyllium-containing products. Only three women denied prior exposure to psyllium. Symptoms developed shortly after small amounts of the cereal were ingested and most commonly included moderate to severe wheezing, throat and chest tightness, and urticaria. All the women required medical therapy, 11 (55%) in an emergency room. Specific IgE and IgG antibodies to various psyllium protein fractions were documented in all the subjects. It was concluded that individuals sensitized by occupational exposure to psyllium dust are at high risk for allergic reactions to ingested psyllium-containing products.[10]

Johns Hopkins University School of Medicine, Baltimore, Md.
[10] James, J. M., Cooke S. K., Barnett, A. and H. A. Sampson. “Anaphylactic reactions to a psyllium-containing cereal.” The Journal of allergy and clinical immunology. Vol. 88, Issue 3, pt. 1. (402-8). Pub. 1991 Sept. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 1890270 [PubMed - indexed for MEDLINE].

Systemic anaphylaxis after ingestion of a psyllium-containing breakfast cereal

Summary: Exposure to Psyllium or its extracts over a long period of time can lead to hyper-sensitivity. Thereafter, if the herb is directly ingested, severe allergic reactions, vomiting, loss of breath, or even death may occur. “Allergic reactions have been described as an occupational hazard among nurses and pharmaceutical workers who handle psyllium-containing laxatives. This study reports the case of a 38-year-old female nurse who ingested a bowl of psyllium-containing Heartwise Cereal (Kelloggs, Battle Creek, MI) and 25 minutes later developed severe systemic anaphylaxis manifested by hypotension, a feeling of constriction in the throat, hoarseness, dyspnea, wheezing, generalized pruritus, urticaria, and vomiting. She was treated with epinephrine, normal saline, diphenhydramine, and methylprednisolone, and recovered completely. Subsequent IgE immunoblot assay was strongly reactive to psyllium. Ingestion of psyllium-containing breakfast foods by sensitized individuals can be associated with life-threatening systemic anaphylaxis.[11]

Division of Emergency Medicine, University of New Mexico, Albuquerque 87131.
[11] Drake, C. L., Moses, E. S. and D. Tandberg. “Systemic anaphylaxis after ingestion of a psyllium-containing breakfast cereal.” The American journal of emergency medicine. Vol. 9, Issue 5. (449-51). Pub. 1991 Sept. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 1863300 [PubMed - indexed for MEDLINE].

Anaphylaxis following ingestion of a psyllium-containing cereal

Summary: Even if you don’t take Psyllium, but are exposed to it occupationally, you can later experience severe health consequences if the herb is directly ingested. “Recently, psyllium hydrophilic mucilloid, a bulk-forming laxative, has been added to breakfast cereals for cholesterol-lowering effects. We report a case of a 60-year-old woman with no prior history of psyllium ingestion who developed anaphylactic symptoms after eating a psyllium-containing cereal. Her only previous exposure was dispensing a psyllium-containing laxative as a nurse. Immunoglobulin E-mediated sensitization was documented by skin testing and basophil histamine release. The literature is reviewed regarding allergic reactions to psyllium. Health care workers and pharmaceutical workers handling psyllium may be at increased risk due to sensitization from inhalation. Physicians and consumers should be aware of potential serious reactions from eating psyllium-containing cereals even without prior history of ingestion of psyllium.[12]

Section of Allergy/Immunology, Loyola University Stritch School of Medicine, Mayhood, Il 60153.
[12] Lantner, R. R., Espiritu, B. R., Zumerchik, P. and M. C. Tobin. “Anaphylaxis following ingestion of a psyllium-containing cereal.” JAMA : the journal of the American Medical Association. Vol. 264, Issue 19. (2534-6). Pub. 1990 Nov 21. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 2232020 [PubMed - indexed for MEDLINE].

Psyllium anaphylaxis

Summary: It is generally undisclosed that exposure to Psyllium in the manufacturing process, or in healthcare settings, can experience serious allergic reactions including constricted breathing, heart rhythm malfunction, swelling, hives, blackouts, and asthma.
“Allergic reactions from handling psyllium have been reported since 1970. Health professionals and workers in laxative-manufacturing plants are at greatest risk. Sensitized people are at risk of life-threatening anaphylactic reactions. Two illustrative cases are presented. The first is A 39-year-old female dialysis nurse with a 3-year history of nasal and eye symptoms from exposure to psyllium. She obtained an over-the-counter psyllium bulk laxative, took it for constipation and developed flushing, tachycardia, urticaria, angioedema, laryngeal edema, and lightheadedness. An epicutaneous skin test and radioallergosorbent test for psyllium were both strongly positive. The second is a 42-year-old female nurse with a history of asthma who had allergic nasal and eye symptoms while dispensing psyllium. She received a prescription for crystallized psyllium, took it by mouth, and developed immediate flushing, tachycardia, urticaria, and angioedema. With subsequent ingestion of psyllium she had, in addition, severe wheezing, lightheadedness, and loss of consciousness. A psyllium epicutaneous skin test was strongly positive. These patient reports illustrate the risk of severe allergic reactions in sensitized people. Ingestion by sensitized people, such as from a routine postoperative and postpartum order, is potentially dangerous.[13]
University of Toronto, Division of Immunology, Wellesley Hospital, Canada.
[13] Sussman, G. L. and W. Dorian. “Psyllium anaphylaxis.” Allergy proceedings: the official journal of regional and state allergy societies. Vol. 11, Issue 5. (241-2). Pub. 1990 Sept.-Oct. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 2258044 [PubMed - indexed for MEDLINE].

(Psyllium) Ispaghula sensitization in workers manufacturing a bulk laxative

Summary: Psyllium manufacturing can be a highly dangerous occupation leading to severe allergic conditions due to exposure to the herb’s material substances. “Exposure to ispaghula dust in a pharmaceutical factory resulted in chest tightness/wheeze, nasal, and ocular or skin symptoms in 48 of 92 exposed workers. Whilst symptoms were not incapacitating in the majority (44) of these, one worker required antihistamines and three others experienced severe respiratory symptoms when exposed to the dust. These three were atopic, had a positive RAST and skin test to ispaghula; a combination unique to them. There was a significant relationship between work-related symptoms and atopic status, however, smoking did not influence symptoms, total serum IgE and specific anti-ispaghula IgE. We conclude that handling ispaghula produces an irritant effect in most exposed people, however, sensitization to the dust can occur with severe respiratory symptoms.”[14]

Department of Tuberculosis and Chest Diseases, University of Wales College of Medicine, Penarth, Glamorgan, U.K.
[14] McConnochie, K., Edwards, J. H. and R. Fifield. “(Psyllium) Ispaghula sensitization in workers manufacturing a bulk laxative.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology. Vol. 20, Issue 2. (199-202). Pub. 1990 Mar. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 2357618 [PubMed - indexed for MEDLINE].

Occupational allergic rhinitis reaction to psyllium

Summary: Especially in individuals already possessing breathing disorders (such as asthma, allergies, rhinitis, etc.), Psyllium exposure can lead to serious medical conditions. “We report studies that document a specific rhinitic reaction that developed as a result of occupational exposure to a psyllium-based powdered laxative. This nurse had a nonatopic family history, personal evidence of atopy (skin test reactions to pollen, cat dander, and house dust), and a significant elevation of antipsyllium IgE. Measurements of nasal and lower airway resistance documented only nasal obstruction to brief inhalational challenge to the laxative. Symptomatic relief was achieved with prior treatment with cromolyn. We suggest that nasal airway challenge can document and assess treatment for occupational rhinitis.”[15]

Department of Medicine, University Hospital of Cleveland, OH 44106.
[15] Schwartz, H. J., Arnold, J. L. and K. P. Strohl. “Occupational allergic rhinitis reaction to psyllium.” Journal of occupational medicine. : official publication of the Industrial Medical Association. Vol. 31, Issue 7. (624-6). Pub. 1989 Jul. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 2769459 [PubMed - indexed for MEDLINE].

Occupational asthma and IgE sensitization in a pharmaceutical company processing psyllium

Summary: Exposure to Psyllium and its physical materials in occupational settings can worsen or even develop severe allergic reactions in employees. “We assessed the prevalence of occupational asthma and IgE sensitization to psyllium in a pharmaceutical company producing psyllium hydrophilic mucilloid, which is used as a laxative. Workers were intermittently exposed, approximately 5 times/yr, for periods of less than 10 days. Of the 140 employees, 130 (93%) were studied before a processing period via a questionnaire spirometry (n = 125), blood sampling (n = 118), and skin prick tests (n = 120) with 7 common inhaled allergens as well as plantain and psyllium. Thirty-nine workers had a history suggestive of occupational asthma. Twenty-three of 120 (19%) showed a skin wheal diameter greater than or equal to 3 mm to psyllium and 31 of 118 (26%) had increased specific IgE antibodies; 39 (32%) workers had at least 1 of these 2 features. Subjects with a questionnaire suggestive of asthma or occupational asthma were further investigated by serial monitoring of peak expiratory flow rates and PC20 methacholine before and during the psyllium processing period. All workers had spirometry repeated during the processing period. Twenty-one subjects who had a PC20 less than or equal to 16 mg/ml (n = 10) and/or decreased their PC20 by a greater than or equal to 3.2-fold difference (n = 4) and/or changed their FEV1 by greater than or equal to 10% (n = 13) during the processing period were referred for inhalation challenges to psyllium in the laboratory. Five of the 18 workers for whom these tests were feasible gave an immediate bronchoconstrictive reaction. (ABSTRACT TRUNCATED AT 250 WORDS)[16]

[16] Bardy, J. D., Malo, J. L., Seguin, P., Ghezzo, H., Desjardins, J., Dolovich, J. and A. Cartier. “Occupational asthma and IgE sensitization in a pharmaceutical company processing psyllium.” The American review of respiratory disease. Vol. 135, Issue 5. (1033-8). Pub. 1987 May. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 3579003 [PubMed - indexed for MEDLINE].


Bulk laxative ileus

Summary: Individuals relying on common laxatives to induce bowel movements may inadvertently develop severe digestive disorders (possibly even requiring surgical intervention) or existing conditions can be worsened through abuse of Psyllium-based products. “In an elderly nursing home resident who had taken excessive dosages of bulk laxative for many years, small-bowel obstruction developed, requiring surgical intervention. A carcinoma of the ascending colon probably was the immediate cause of the obstruction, which resulted in the accumulation and inspissations of the bulk laxative throughout the small bowel. Great care should be exercised in the long-term use of these laxatives.”[17]

[17] Berman, J. I. and M. J. Schultz. “Bulk laxative ileus.” Journal of the American Geriatrics Society. Vol. 28, Issue 5. (224-6). Pub. 1980 May. Online. Accessed: 18 Jan 2007. (Highlighted text by Colon Cleanse and Constipation Resource Center). Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed PubMed PMID: 7365186 [PubMed - indexed for MEDLINE].
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