Introduction
During the COVID-19 pandemic, multiple medications and supplements have received consideration for either prophylaxis and/or treatment. This case describes an adverse reaction to the herbal medication Lomatium dissectum when it was used for prophylaxis against COVID-19 infection.
Case Description
A 57 y/o female presented with a 1 day history of a diffuse red, itchy rash. She had been in good health prior to this. Her only daily medications were magnesium and vitamins. Six days prior to presentation, on the advice of a physician family member, she began taking Lomatium dissectum extract as prophylaxis against COVID-19. The day prior to her visit, she developed rapid onset, body wide rash that was intensely pruritic.
Physical exam: Afebrile patient in moderate distress secondary to pruritis from a diffuse maculopapular rash, sparing only the palms and soles. No urticaria or angioedema. Mucosal membranes without lesion. Exam otherwise unremarkable. Rapid strep was negative.
A literature review found a single case report with similar findings The Lomatium medication was stopped and she was treated with high dose antihistamine and prednisone. Her rash resolved in 5 days, during which time she required another physician office visit and an emergency department evaluation for intense itching.
Discussion
In the herbal medication literature, Lomatium dissectum is characterized as an expectorant and treatment for febrile respiratory illnesses. A rash that occurs in the first week of treatment, lasting for 5 days, is described as a possible side effect. Allergists should be aware of this possible adverse drug reaction when evaluating patients for acute rash reactions.