Epinephrine-resistant anaphylaxis in a patient taking propranolol hydrochloride

A patient taking propranolol hydrochloride, 40 mg twice daily, had a constitutional reaction several minutes after receiving a maintenance allergy injection. When the reaction proved resistant to treatment with aqueous adrenalin, intubation with 100% oxygen ventilation and the intravenous administration of sodium bicarbonate with pancuronium bromide, diphenhydramine hydrochloride and dexamethasone was required for the patient's recovery. Physicians should be aware that, in allergy patients, low doses of propranolol hydrochloride can result in acute pulmonary failure.