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March 16, 1984

β-Blockade in Stinging Insect Anaphylaxis

Author Affiliations

Newton Lower Falls, Mass

JAMA. 1984;251(11):1432. doi:10.1001/jama.1984.03340350026019

To the Editor.—  Report of a Case.—A 65-year-old woman, taking daily antihypertensive drugs—propranolol hydrochloride (280 mg), hydralazine (125 mg), and hydrochlorothiazide (50 mg)—for two years, with average BP readings of 140/90 mm Hg, was stung by an insect. Although she had previously been stung with no untoward reaction, this time, within ten minutes, she experienced generalized hives and swelling of her tongue and throat. She collapsed outdoors and within a few minutes was brought to the hospital with hives and hypotension (60/0 mm Hg) and was responsive only to painful stimuli.Despite several injections of subcutaneous epinephrine (0.50 mL, 1/1,000), and intravenous (IV) hydrocortisone (100 mg) and, although the hives and angioedema disappeared, her blood pressure continued to drop and her pulse rate decreased to 30 beats per minute. An ECG showed sinus bradycardia, occasional premature ventricular beats, and atrial arrhythmia. When IV epinephrine (6 mL, 1/10,000) was administered