Acerola and Latex Allergy
Ranulf-Heimsoth et al present the case of a 37 year old man who developed anaphylaxis after drinking a glass of apple juice that has been supplemented with acerola (often added to increase vitamin C content of products such as juices).
Testing showed that the man experienced no reactions to apple juice. Further testing identifies acerola as the problem and the allergen for latex-acerola cross-reactivity was identified as 'Hev b 6.01'. They recommend that allergists include acerola on the list of latex-cross-reactive food allergens.
Anaphylactic reaction to apple juice containing acerola: Cross-reactivity to latex due to prohevein.
Raulf-Heimsoth M, Stark R, Sander I, Maryska S, Rihs H-P, Brüning T, Voshaar T.
J Allergy Clin Immunol 2002;109:4.
Raulf-Heimsoth M, Stark R, Sander I, Maryska S, Rihs H-P, Brüning T, Voshaar T.
J Allergy Clin Immunol 2002;109:4.
Anorexia Nervosa and Histamine Intolerance
Stolze et al present the case of a woman who had suffered from weight loss, stomach problems, headaches, flushing and bronchial asthma for several years. The diagnosis had been anorexia nervosa.
After following a diet low in histamine the woman experienced weight gain and an improvement in all her other symptoms. It therefore appears that the condition she had in fact been suffering from was histamine intolerance.
Stolze I, Peters KP, Herbst RA. Histamine intolerance mimics anorexia nervosa. Hautarzt 2010 Sep;61(9):776-778.
Adverse Reactions to Food Additives
Randhawa and Bahna carried out a review on hypersensitivity reactions to food additives, diagnosis, and management. One of things they found is that there is little information available in the world of medical literature and speculate that this may be due to the difficulties with diagnosing problems with food additives. [It is my own experience of reviewing the literature – and I suspect that food additives as a cause of symptoms is rarely considered by most medical professionals.]
They recommend that food additives should be suspected as the culprit in individuals who report a history of reactions to a number of unrelated foods or to a certain food when commercially prepared but not when prepared at home.
The major problem in dealing with reactions to additives is the identification of the offending agent(s). They argue that apart from a careful history taking, allergy skin testing or in-vitro testing are rarely useful. Trials of elimination and reintroduction may be more helpful. Once the offending additive is confirmed, the only treatment is avoidance.
Because accidental exposure often happens, they recommend that individuals with a history of severe reactions should have self-injectable epinephrine and wear MedicAlert identification
[One way of helping identify a food additive problem is to keep a very detailed Food Diary.]
Randhawa S, Bahna SL. Hypersensitivity reactions to food additives. Curr Opin Allergy Clin Immunol. 2009 Jun;9(3):278-83.
Adverse reactions to alcoholic beverages are common and have usually been put down to metabolic differences in individuals and/or the histamine content.
Pure ethanol has rarely been reported as a cause of hypersensitivity reactions. Ehlers et al decided to test whether ethanol itself was responsible for alcohol hypersensitivity in individuals who had experienced anaphylactic reactions after alcohol intake.
Interestingly skin prick tests were all negative but oral challenges resulted in reactions in 50% of those studied. Ethanol itself can, therefore, be responsible for reactions but any testing must take into account the failure of skin prick testing in provoking reactions.
Ethanol as a cause of hypersensitivity reactions to alcoholic beverages. Ehlers I, Hipler UC, Zuberbier T, Worm M. Clin Exp Allergy 2002;32(8):1231-5.
A Japanese study looked at the role of food in triggering irregular, and unpredictable, episodes of atopic dermatitis. he study involved 195 individuals - 86 of these were found to be reacting to foods.
The main problem foods were chocolate, cheese, coffee, yoghurt, glutinous rice cake, soy sauce and fermented soybeans. For the majority food intolerance and not to allergy was the cause - specific IgE values to the offending foods were mostly negative.
Role of foods in irregular aggravation of atopic dermatitis. Uenishi T, Sugiura H, Uehara M. J Dermatol 2003;30(2):91-7.
After eating guacamole dip with chips, a fifteen year old boy developed coughing, wheezing, nasal stuffiness, generalized urticaria and swelling around the eyes. The reaction was treated as an anaphylactic reaction and skin testing confirmed an allergy to avocado which is the primary ingredient of guacamole.
As anaphylaxis to avocado is often linked with latex sensitization, tests for latex sensitivity were also carried out but these were all negative.
Anaphylaxis related to avocado ingestion: a case and review. Abrams EM, Becker AB, Gerstner TV. Allergy Asthma Clin Immunol 2011 Jun 10;7(1):12.
Contact dermatitis and salami skin
A twenty-one year old woman suffered from chronic recurrent dermatitis on her lower arms. Her symptoms were always worse in the evening and during the night, and reduced noticeably over weekends. When on holiday, her dermatitis completely cleared within seven days. Various tests were carried out and eventually the culprit was found to be salami skin – the woman worked in a delicatessen store where she regularly cut and sold salami sausages.
Contact dermatitis caused by salami skin. Wantke F, Simon-Nobbe B, Poll V, Gotz M, Jarisch R, Hemmer W. Contact Dermatitis 2011 Feb;64(2):111-114
Eggplant / Aubergine Allergy
Babu and Venkatesh tested six people allergic to aubergine to establish how many parts of the aubergine were implicated. All showed positive skin prick tests to peel, pulp, raw, and cooked aubergine extracts.They concluded that aubergine has allergens in all of its edible parts with a preponderance in the peel.
Babu BNH; Venkatesh YP. Clinico-immunological analysis of eggplant (Solanum melongena) allergy indicates preponderance of allergens in the peel. WAO Journal 2009;2(9):192-200.
Fermented soybeans: natto
A 38 year old man developed an anaphylactic reaction with flushing, generalized urticaria, conjunctival redness, and breathing problems three hours after eating cold Chinese noodles. He had avoided natto for the previous year as a result of experiencing anaphylactic reactions half a day after eating natto. Skin prick tests were strongly positive for natto and the soup of cold Chinese noodles. The tests were also positive for poly gamma-glutamic acid (PGA), which is a major constituent of natto mucilage, an ingredient of the noodle soup.
The man was diagnosed with late-onset anaphylaxis to PGA contained in natto and the cold Chinese noodle soup. The delayed reaction was thought to be due to a delayed absorption of PGA which has to biodegrade to peptides sufficiently small enough to be absorbed in the bowel.
Inomata et al note that PGA has recently been applied to a wide range of fields such as foods, cosmetics, and medicine and that anyone with a sensitivity to to PGA of natto should avoid not only natto but also other materials containing PGA.
Late-onset anaphylaxis due to poly (gamma-glutamic acid) in the soup of commercial cold Chinese noodles in a patient with allergy to fermented soybeans (natto). Inomata N, Chin K, Nagashima M, Ikezawa Z. Allergol Int 2011 Mar 25.
Reactions to Chicory
Pirson et al reported that a person working in a factory producing inulin from chicory developed rhinoconjunctivitis and asthma to the dust of dry chicory roots and oral allergy syndrome to raw fruits and vegetables.
A provocation test with dry chicory induced acute rhinoconjunctivitis and an immediate asthmatic response. Skin prick test results were positive to birch pollen and chicory (fresh and dry), and negative for inulin.
Occupational rhinoconjunctivitis and asthma caused by chicory and oral allergy syndrome associated with bet v 1-related protein. Pirson F, Detry B, Pilette C. J Investig Allergol Clin Immunol. 2009;19(4):306-10.
Tongue erosions and diet cola
Jacobs and Steele report on the case of a 38-year-old woman who presented with a 10-year history of painful ulcerations on her tongue. She reported that she drank large quantities of diet cola and some orange juice daily and that she used cinnamon flavoured toothpaste and mouthwash nightly.
Patch testing showed positive reactions to balsam of Peru (a fragrance as well as a flavouring agent put in cola drinks that cross-reacts with orange juice) and cinnamic aldehyde. The woman was diagnosed with allergic contact dermatitis, placed on a restricted diet and a fragrance-free regimen. Her condition resolved.
Jcob SE, Steele T. Tongue erosions and diet cola. Ear Nose Throat J. 2007 Apr;86(4):232-3.
Urticaria and Pseudo Allergens
Chronic spontaneous urticaria is a skin disorder that is difficult to manage and can last for years. Eliminating pseudoallergens from the diet can reduce the severity of the urticaria and so improve quality of life.
Magerl et al define 'pseudoallergens' as substances that intolerance reactions that are similar to true allergic reactions. These substances include food additives, vasoactive substances such as histamine, and some natural substances in fruits, vegetables and spices (such as salicylate). This study involved individuals who had moderate or severe chronic spontaneous urticaria that had not responded adequately to treatment in primary care. For 3 weeks, 140 people followed a pseudoallergen-free diet.
Twenty (14%) were classed as strong responders, 19 (14%) as partial responders, and 9 (6%) made a substantial reduction in their medication without experiencing worse symptoms or quality of life. The authors concluded that a pseudoallergen-free diet is beneficial for one in three patients and is a safe, healthy and cost-free form of intervention.
Magerl M, Pisarevskaja D, Scheufele R, Zuberbier T, Maurer M. Effects of a pseudoallergen-free diet on chronic spontaneous urticaria: a prospective trial. Allergy. 2009 Oct 1.
Urticaria caused by antihistamines
Antihistamines are commonly used drugs when treating allergy symptoms. They can however lead to unwanted reactions themselves. Rodriguez et al present details of five individuals who developed urticaria after taking antihistamines. Testing confirmed that the cause of the reactions was the antihistamines.
Rodríguez del Río P, González-Gutiérrez ML, Sánchez-López J, Nuñez-Acevedo B, Bartolomé Alvarez JM, Martínez-Cócera C. Urticaria caused by antihistamines: report of 5 cases. J Investig Allergol Clin Immunol. 2009;19(4):317-20.
Vasculitis and Food
This study outlines the cases of two children with food induced vasculitis. In an 8-year-old girl, vasculitis was found to be caused by a sensitivity to cow's milk and also to eggs.
A 23-month-old girl with vasculitis was found to be sensitive to chocolate: the vasculitis went into remission when chocolate was avoided and only returned after accidental ingestion of products containing cocoa.
Businco L, Falconieri P, Bellioni-Businco B, Bahna SL.Severe food-induced vasculitis in two children. Pediatr Allergy Immunol. 2002 Feb;13(1):68-71.
Wine Processing Aids
A study by Kirschner et al set out to establish whether traces of egg, milk, and fish derived processing aids used in winemaking might elicit clinical reactions in food-allergic individuals.
Five German wines were fined with high doses of egg albumin, lysozyme, milk casein, fish gelatin, or isinglass, and filtered. Fourteen adults with allergy to egg, milk, or fish were involved in the study. Skin prick tests were performed with fining agents, and fined and unfined wines. All patients underwent double-blind placebo-controlled food challenges with fined and unfined wines.
Although concentrated fining agents containing ovalbumin, lysozyme, and casein were allergenic in the skin prick test, none of the study participants reacted adversely in provocation tests to fined wine. The authors concluded that wines treated with fining agents, at commercial concentrations, appear not to present a risk to allergic individuals when filtered.
Kirschner S, Belloni B, Kugler C, Ring J, Brockow K. Allergenicity of wine containing processing aids: a double-blind, placebo-controlled food challenge. J Investig Allergol Clin Immunol. 2009;19(3):210-7.