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Am Fam Physician. 2005;71(11):2048-2050

to the editor: I would like to report a case of urticaria following cicada ingestion, related to the recent Brood X cicada invasion.

At the urgent care center in Bloomington, Indiana, where I work, we saw a 45-year-old man who had consumed approximately 30 cicadas and then subsequently developed an erythematous, pruritic rash from his head to mid-calf 30 to 45 minutes after the ingestion. On initial presentation, he complained of an “itching” in his throat but denied any shortness of breath.

His medical history revealed no allergies to medications, but he did report an allergy to shellfish, which had previously caused symptoms similar to the ones he was experiencing. The medications he was taking included f luticasone nasal spray, inhaled fluticasone/salmeterol, zafirlukast, and tamsulosin. He had taken his scheduled medicines that day, as well as two 25-mg tablets of diphenhydramine, orally.

A physical examination revealed: respiratory rate 16 breaths per minute, pulse rate 96 beats per minute, temperature 98.0°F (36.7°C), blood pressure 124/68 mm Hg, and arterial oxygen saturation (SaO2) 98 percent on room air. His heart rhythm was regular and lung fields were clear. We administered desloratadine 5 mg orally, methylprednisolone 80 mg intramuscularly, and 1:1,000 epinephrine 0.3 mL subcutaneously. The patient was monitored with continuous electrocardiography over the next several hours. He began to feel better, and was discharged home in stable condition. The rash had almost completely resolved.

Further history taking revealed that the patient had downloaded a recipe from the Internet and had prepared the cicadas by sautéing them in butter and garlic. Physicians should caution patients who have experienced allergic reactions to shellfish to avoid ingesting cicadas.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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