Angelica Pubescens Root

Dosage for Angelica Pubescens Root as an allergenic extract is highly individualized and is not measured in standard milligrams like conventional tablets. Instead, it is measured by volume and concentration.

Diagnostic Skin Prick Testing (SPT)

For adults, a single drop of the 1:10 or 1:20 w/v extract is applied to the skin (usually the forearm or back). A sterile lancet is then used to prick the skin through the drop. A positive control (histamine) and a negative control (saline/glycerin) are used simultaneously for comparison.

Intradermal Testing

If the SPT is negative but a high clinical suspicion of allergy remains, a dose of 0.02 to 0.05 mL of a 1:100 or 1:1000 w/v dilution may be injected intradermally to create a 2-3 mm bleb.

Immunotherapy (SCIT)

If used for desensitization, the 'build-up' phase involves weekly injections starting at a very low dose (e.g., 0.1 mL of a 1:10,000 dilution) and gradually increasing over 3–6 months to a 'maintenance dose' (typically 0.5 mL of a 1:10 or 1:20 concentration).

Angelica Pubescens Root extract can be used in children, but extreme caution is required.

• Infants and Toddlers: Skin testing is generally avoided unless strictly necessary due to the sensitivity of infant skin and the risk of systemic reactions.
• Children (Age 5+ ): The procedure for SPT is identical to adults, though fewer tests may be performed in a single session to minimize discomfort and systemic load.
• Dose Adjustments: There is no specific weight-based dose adjustment for skin testing, but the total number of different allergens tested simultaneously is often reduced in smaller children.

Renal Impairment

No specific dosage adjustment is required for diagnostic skin testing in patients with renal impairment, as systemic absorption is minimal. However, for immunotherapy, clinicians should monitor for delayed clearance of metabolic byproducts.

Hepatic Impairment

Patients with severe hepatic impairment should be monitored closely if undergoing high-dose immunotherapy, as the liver is responsible for the metabolism of the coumarin constituents found in the root extract.

Elderly Patients

In patients over 65, skin reactivity may be diminished (reduced mast cell density). This can lead to false-negative results. Clinicians may need to rely more heavily on in vitro (blood) testing like sIgE (Specific IgE) assays.

This medication is never 'taken' by the patient at home in its extract form. It is administered exclusively by healthcare professionals in a clinical setting.

• Administration Site: Usually the volar surface of the forearm or the upper back.
• Preparation: The skin must be cleaned with alcohol and allowed to dry completely before the extract is applied.
• Observation: The patient must remain in the clinic for at least 30 minutes after administration to monitor for signs of anaphylaxis.
• Storage: Vials must be stored in a refrigerator at 2°C to 8°C (36°F to 46°F). They should never be frozen.

In the context of immunotherapy, if a dose is missed:

• < 1 week late: Continue with the scheduled dose.
• 1-2 weeks late: The dose may need to be reduced to the previous level.
• > 4 weeks late: The build-up process may need to be restarted from a much lower concentration to ensure safety.

An 'overdose' in the context of an allergenic extract usually refers to the administration of too high a concentration or too large a volume, leading to a systemic allergic reaction.

• Signs: Hives (urticaria), swelling of the throat (angioedema), wheezing, rapid heart rate, or a sudden drop in blood pressure.
• Emergency Measures: Immediate administration of epinephrine (EpiPen), followed by antihistamines, corticosteroids, and emergency transport to a hospital.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or attempt to use these extracts outside of a medical facility.

The most common side effects of Angelica Pubescens Root extract are localized to the site of administration. These are often expected as part of the diagnostic process.

• Local Wheal and Flare: A raised, pale bump (wheal) surrounded by a red area (flare). This is the hallmark of a positive test and is usually itchy.
• Pruritus (Itching): Intense itching at the site of the skin test, which typically subsides within 1–2 hours.
• Erythema (Redness): Redness of the skin around the test site that may persist for several hours.

• Delayed Local Reaction: Swelling and redness that appears 6–24 hours after the test. This is often a Type IV hypersensitivity response.
• Local Pain: A stinging or burning sensation during the skin prick or intradermal injection.
• Fatigue: Some patients report feeling unusually tired for a few hours following a large battery of skin tests.

• Systemic Urticaria: Hives appearing on parts of the body far away from the injection site.
• Photosensitivity: Because Angelica pubescens contains furanocoumarins, high systemic levels could theoretically increase the skin's sensitivity to UV light, leading to a rash or sunburn-like reaction.
• Vasovagal Response: Fainting or lightheadedness triggered by the needle prick or the sight of the procedure, rather than the extract itself.

> Warning: Stop the administration process and call for emergency help immediately if you experience any of the following symptoms of Anaphylaxis:

• Respiratory Distress: Difficulty breathing, shortness of breath, or a 'tightness' in the chest.
• Laryngeal Edema: Swelling of the throat, feeling like the throat is closing, or a hoarse voice.
• Hypotension: A sudden drop in blood pressure, which may feel like dizziness, confusion, or fainting.
• Angioedema: Significant swelling of the lips, tongue, or around the eyes.
• Generalized Hives: Rapidly spreading, itchy welts across the entire body.

For diagnostic use, there are no known long-term side effects. For those undergoing long-term immunotherapy (3–5 years):

• Persistent Nodules: Small, hard lumps at the injection site that may take weeks to resolve.
• Immunological Shifts: Changes in the balance of T-helper cells (Th1 vs Th2), which is the intended therapeutic effect but can occasionally lead to changes in how the body reacts to other unrelated allergens.

While non-standardized extracts may not always carry a specific boxed warning in the same way as high-potency standardized extracts (like Grass Pollen or Cat Hair), the general class warning for allergenic extracts applies:

WARNING: RISK OF SEVERE ALLERGIC REACTIONS

• This product can cause severe, life-threatening systemic reactions, including anaphylaxis.
• It must only be administered in a setting where emergency equipment (oxygen, epinephrine, IV fluids) and trained personnel are immediately available.
• Patients with unstable asthma are at a higher risk for fatal reactions.

Report any unusual symptoms or delayed reactions to your healthcare provider immediately.

Angelica Pubescens Root extract is intended for professional use only. It is a biological product that carries the inherent risk of triggering the very allergic symptoms it is designed to diagnose. Patients must be screened for current health status before any administration. If you are currently experiencing an asthma flare-up or have a fever, the procedure should be postponed.

No specific FDA black box warning exists solely for 'Angelica Pubescens Root' as a unique entity, but it falls under the General Boxed Warning for Allergenic Extracts. This warning emphasizes that these products can cause anaphylaxis and should only be used by clinicians who are experts in the management of life-threatening allergic reactions. Patients must be observed for at least 30 minutes post-injection.

• Anaphylaxis Risk: This is the primary concern. Risk factors include a history of severe asthma, current use of Beta-Blockers (which can make epinephrine less effective), and high levels of baseline sensitivity.
• Asthma Stability: Patients with poorly controlled or unstable asthma should not undergo skin testing or immunotherapy with Angelica Pubescens Root, as they are at significantly higher risk for a fatal bronchospasm.
• Dermatographism: Patients with 'skin writing' (where any touch causes a hive) may produce false-positive results, making the test uninterpretable.
• Phototoxicity: Due to the presence of psoralens and other coumarins in the Angelica genus, patients should avoid excessive sun exposure or UV tanning beds for 24 hours after a significant exposure to the extract.

• Observation Period: A mandatory 30-minute wait in the doctor’s office after the test.
• Peak Flow Monitoring: For patients with asthma, a peak flow meter may be used before and after the procedure to ensure lung function has not been compromised.
• Skin Assessment: Evaluation of the test site 15–20 minutes after the prick.

Generally, Angelica Pubescens Root does not affect the ability to drive. However, if a patient experiences a vasovagal response (fainting) or a systemic reaction requiring antihistamines (which cause drowsiness), they should not drive until symptoms have fully cleared.

Alcohol should be avoided on the day of testing. Alcohol can increase blood flow to the skin (vasodilation), which may potentially enhance the size of a wheal and flare reaction or accelerate the systemic absorption of the allergen.

There is no 'withdrawal' from Angelica Pubescens Root extract. However, if a patient develops a systemic reaction, the clinician will immediately discontinue the testing or immunotherapy and may permanently contraindicate future use of this specific extract.

> Important: Discuss all your medical conditions, especially respiratory or heart problems, with your healthcare provider before starting Angelica Pubescens Root.

• Beta-Blockers (e.g., Propranolol, Metoprolol): These medications are contraindicated in many patients undergoing allergy testing or immunotherapy. In the event of an 'overdose' or anaphylaxis, Beta-blockers can block the effects of epinephrine, making a life-threatening reaction much harder to treat.
• MAO Inhibitors (e.g., Phenelzine): These can potentiate the effects of sympathomimetics used to treat reactions, leading to hypertensive crises.

• ACE Inhibitors (e.g., Lisinopril): Some studies suggest ACE inhibitors may increase the risk of systemic reactions or worsen the severity of hypotension during anaphylaxis.
• Tricyclic Antidepressants (e.g., Amitriptyline): Similar to MAOIs, these can interfere with the treatment of an allergic emergency.

• Antihistamines (e.g., Loratadine, Cetirizine, Diphenhydramine): These medications must be stopped 3–7 days before diagnostic testing. They block the H1 receptors in the skin, which will prevent the 'wheal and flare' from forming, leading to a false-negative result.
• H2 Blockers (e.g., Famotidine): These can also slightly suppress skin reactivity and should ideally be discontinued before testing.
• Systemic Corticosteroids: Long-term use of oral steroids (like Prednisone) can suppress the immune response and diminish skin test results.

• Celery, Carrots, and Fennel: Because these belong to the same family (Apiaceae) as Angelica, eating them shortly before testing might theoretically prime the immune system and lead to a more robust (or systemic) reaction in highly sensitive individuals.
• Caffeine: High doses of caffeine can cause tachycardia, which may complicate the monitoring of a patient's heart rate during a potential allergic reaction.

• Warfarin and Anticoagulants: Angelica Pubescens Root contains coumarins, which have natural anticoagulant properties. While the amount absorbed from a skin test is tiny, patients on blood thinners should be aware of a theoretical (though unlikely) increased risk of bruising at the injection site.
• St. John’s Wort: This herb increases photosensitivity, which could synergize with the coumarins in Angelica to cause skin irritation upon UV exposure.

• Skin Test Suppression: Any drug with antihistaminic properties (including some sleep aids and anti-nausea meds) will interfere with the diagnostic accuracy of the test.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, especially those for blood pressure or allergies.

Angelica Pubescens Root extract must NEVER be used in the following circumstances:

• Previous Anaphylaxis to Angelica: If a patient has a documented history of a life-threatening reaction to this specific extract or its botanical components.
• Severe, Uncontrolled Asthma: Patients with a Forced Expiratory Volume in 1 second (FEV1) of less than 70% of predicted values are at extreme risk for fatal bronchospasm during testing.
• Acute Infection: Testing should not be performed if the patient has a fever or active systemic infection.

Clinicians must perform a careful risk-benefit analysis in these cases:

• Pregnancy: While not directly teratogenic, the risk of anaphylaxis (which causes fetal hypoxia) usually outweighs the benefit of diagnostic testing during pregnancy.
• Beta-Blocker Therapy: If the medication cannot be safely paused, the risk of 'epinephrine-resistant anaphylaxis' must be considered.
• Severe Atopic Dermatitis: If the skin is too inflamed or damaged, there may be no 'clear' area of skin to perform an accurate test.

Patients should be aware of potential cross-reactions with other members of the Apiaceae family. If you are severely allergic to any of the following, you may react to Angelica Pubescens Root:

• Celery
• Carrots
• Parsley
• Coriander/Cilantro
• Anise
• Dill

> Important: Your healthcare provider will evaluate your complete medical history, including all known allergies, before prescribing or administering this extract.

FDA Pregnancy Category: Not Assigned.

There are no adequate and well-controlled studies of Angelica Pubescens Root extract in pregnant women. The primary concern is not the substance itself, but the risk of a systemic allergic reaction (anaphylaxis). Anaphylaxis in a pregnant woman can lead to a sudden drop in blood pressure and uterine contraction, resulting in fetal hypoxia (lack of oxygen) or even fetal death. Consequently, most allergists recommend postponing diagnostic skin testing and the initiation of immunotherapy until after delivery.

It is unknown whether the allergenic proteins or coumarin metabolites of Angelica Pubescens Root are excreted in human milk. Because systemic absorption from skin testing is minimal, it is generally considered low-risk for the nursing infant. However, for mothers on high-dose immunotherapy, caution is advised, and the infant should be monitored for any signs of allergic skin rashes.

Angelica Pubescens Root extract is used in children, but the clinical utility must be weighed against the discomfort and risk.

• Safety: Children are more prone to rapid-onset systemic reactions.
• Efficacy: Skin testing is highly accurate in children over age 2. In infants under 6 months, skin reactivity is often too low for reliable results.
• Growth: There is no evidence that allergenic extracts affect growth or development.

In patients over 65 years of age:

• Reduced Reactivity: The skin's histamine response decreases with age, which can lead to smaller wheal sizes and potential false negatives.
• Comorbidities: Elderly patients are more likely to have cardiovascular disease or be on medications (like Beta-blockers) that increase the risk of a complicated allergic reaction.
• Renal Function: While not a factor for skin testing, age-related decline in kidney function should be considered if high-dose extracts are used therapeutically.

No specific dose adjustments are provided for renal impairment in the context of diagnostic testing. In the rare event of systemic absorption, the coumarin metabolites are cleared renally, so patients with Stage 4 or 5 Chronic Kidney Disease (CKD) should be monitored for any delayed side effects.

Patients with significant liver disease (Child-Pugh Class B or C) may have impaired metabolism of the furanocoumarins found in the root. While unlikely to be clinically significant for a single skin test, this population should be monitored for increased photosensitivity.

> Important: Special populations require individualized medical assessment. Always inform your specialist of your full health status.

At the diagnostic level, Angelica Pubescens Root extract functions as an antigenic stimulus. The extract contains specific proteins (allergens) that are recognized by the immune system of sensitized individuals. Upon contact with the dermal layer, these proteins cross-link IgE antibodies bound to high-affinity receptors (FcεRI) on the surface of mast cells and basophils. This cross-linking triggers a signal transduction cascade involving tyrosine kinases (such as Syk), leading to the release of pre-formed mediators like histamine and the de novo synthesis of leukotrienes.

At a phytochemical level, the root is rich in coumarins, particularly Osthole. Osthole has been shown in in vitro studies to inhibit the release of histamine from mast cells at certain concentrations, suggesting a complex pharmacological profile where the whole extract can trigger an allergy, but specific isolated components may have anti-inflammatory properties.

• Onset of Action: For skin testing, the 'wheal and flare' reaction typically begins within 5 minutes and reaches its peak at 15 to 20 minutes.
• Duration of Effect: The local allergic reaction usually fades within 2 to 4 hours, though a 'late-phase' swelling can occur 6 to 12 hours later.
• Tolerance: Repeated exposure via immunotherapy leads to the production of IgG4 antibodies (blocking antibodies) and the induction of regulatory T-cells (Tregs), which eventually suppress the IgE-mediated response.

| Parameter | Value |

|---|---|

| Bioavailability | < 1% (Topical/Prick); ~100% (Subcutaneous) |

| Protein Binding | Variable (Albumin binding for coumarins) |

| Half-life | Proteins: Minutes to Hours; Osthole: ~5-7 hours |

| Tmax | 15-20 minutes (Local reaction) |

| Metabolism | Hepatic (CYP3A4/2D6 for coumarin components) |

| Excretion | Renal (Primary route for metabolites) |

• Molecular Components: Includes Osthole (C15H16O3), Columbianadin, and various glycoproteins.
• Solubility: The extract is typically prepared in a mixture of water, sodium chloride, and glycerin (for stability).
• Structure: As a non-standardized extract, it is a complex biological mixture rather than a single chemical entity.

Angelica Pubescens Root belongs to the Non-Standardized Food Allergenic Extract [EPC] class. It is grouped with other botanical and food extracts used for diagnostic and therapeutic immunological purposes.