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A 34-year-old man presented to the emergency room with severe allergic periorbital oedema, facial angioedema and respiratory symptoms. He was treated and referred for evaluation. His only new medication was the recent use of Restasis eye drops for 'dry eyes', which contained castor oil [dosage and duration of therapy to reaction onset not stated]. Prick puncture testing revealed 3+ to 4+ reactivity to many nuts and seeds; castor oil testing was negative. Skin tests were conducted with fresh castor seeds, and castor seeds in sodium chloride solution, which demonstrated a 3+ to 4+ reactivity [patient outcome not stated].