D2.251 - Anaphylaxis due to Andrographis panniculata - an emerging problem

Andrographis panniculata is a herb commonly used in Indian and Chinese medicine and is increasingly used in Australia in herbal supplements, with claimed benefits for immune support and for managing viral infections. It is often co-formulated with other herbs, most commonly echinacea and olive leaf extract, under the brand ‘ArmaForce’

Since 2005, the Australian Therapeutic Goods Association has received more than 300 reports of anaphylaxis and/or hypersensitivity to medicines containing andrographis. In June 2024, a 37-year-old father of two died of a fatal anaphylaxis following ArmaForce ingestion.

We report seventeen anaphylactic reactions in twelve patients following ingestion of Andrographis panniculata occurring in Sydney, Australia between 2015 and 2024. 

The mean age of patients was 41 years (range 17 to 69 years). The reason for use of Andrographis panniculata related to viral upper respiratory tract infection in all cases. The median number of reactions per patient was one; one patient had two reactions, and two patients had three reactions each. ArmaForce was the formulation causing the reaction in 15 of 17 reactions. No prior known exposure to Andrographis panniculata was reported in three reactions, suggesting a non-IgE based mechanism in some patients. Emergency medical care was sought in only five of 17 reactions; four of these were treated with adrenaline. Skin testing with crude tablet slurry was performed in five cases and was negative in all five. A challenge with 1/4 tablet of ArmaForce was performed in one patient, resulting in anaphylaxis requiring a single 300 mcg dose of adrenaline.

Clinicians should be alert for the possibility of anaphylaxis due to Andrographis panniculata. Cases of anaphylaxis should be reported to medicines safety agencies.