Beware beta-adrenergic blockers in patients with severe urticaria!

The risks of beta-blockers in asthmatics are well known. However, there are increasing reports of severe, and often refractory, anaphylaxis in patients taking beta-blockers who experience other allergic phenomena. We describe the case of a 69-year-old lady with long-standing recurrent angio-oedema and giant urticaria who was placed on atenolol. Mechanisms whereby beta-blockers may precipitate or exacerbate anaphylaxis are outlined and the treatment of patients with anaphylaxis, taking beta-blockers, is discussed.