More Research Updates
Allergy to Mint in Chocolate
Aziz and Dioszeghy describe the case of a woman who developed extreme swelling on one side of her tongue and ulceration after eating mint chocolate. The culprit was identified as being the mint in the chocolate. Recovery took several months.
Aziz O, Dioszeghy C. Allergic hemiglossitis as a unique case of food allergy: a case report. J Med Case Reports. 2008 Mar 6;2:71.
Dragon Fruit Allergy
Kleinheinz et al report on the case of a 19-year-old woman who experienced two allergic reactions 5-15 minutes after drinking fruit juice. Testing identified that the culprit in the fruit juice was dragon fruit.
[A pitaya or pitahaya is the fruit of several cactus species. These fruit are commonly known as dragon fruit.]
Kleinheinz A, Lepp U, Hausen BM, Petersen A, Becker WM. Anaphylactic reaction to (mixed) fruit juice containing dragon fruit. J Allergy Clin Immunol 2009 Jul 9.
Enterocolitis
Enterocolitis is an inflammation of the colon and small intestine. This study set out to examine the demographic characteristics, causative foods, clinical features, treatments, and outcomes for children with acute food protein-induced enterocolitis syndrome. Thirty-five children experienced 66 episodes of food protein-induced enterocolitis syndrome. The average age at was 5.5 months. They quite often had a number of episodes before a correct diagnosis was made.
The majority reacted to a single food but 6 reacted to two foods. The problem foods were rice, soy, cow's milk, vegetables and fruits, oats, and fish . In the 66 episodes, vomiting was the most common symptom, followed by lethargy, pallor, and diarrhoea.
They concluded that "misdiagnosis and delays in diagnosis for children with food protein-induced enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations".
Food Protein-Induced Enterocolitis Syndrome: 16-Year Experience. Sam Mehr, Alyson Kakakios, Katie Frith, and Andrew S. Kemp. Pediatrics. published 2 February 2009, 10.1542/peds.2008-2029
Barley Starch Syrup and Cereal Allergies
It is not known whether the trace amounts of proteins that may remain in cereal-starch derived food ingredients after food processing can trigger allergic symptoms in cereal-allergic individuals. Nermes et al carried out a study to find out if barley starch syrup causes allergic reactions in individuals with allergy to wheat, barley, rye or oats.
The study involved 15 children with cereal allergies. When exposed to cereals, seven of the children (47%) showed immediate type reactions, such as urticaria, rash or anaphylaxis. Eight of the children (53%) showed delayed type reactions, such as deterioration of atopic dermatitis or diarrhoea.
The fifteen children were exposed to barley starch syrup and none of them showed any objective signs of allergy. On skin-prick tests, five of the children (33.3%) showed a positive reaction to at least one of the cereals but none of them to barley starch syrup. The authors conclude that they are 98% confident that at least 90% of individuals with verified cereal allergies will not react with allergic symptoms to barley starch syrup.
Nermes M, Karvonen H, Sarkkinen E, Isolauri E. Safety of barley starch syrup in patients with allergy to cereals. Br J Nutr. 2009 Jan;101(2):165-8.
Buckwheat Allergy
Varga et al note that buckwheat is known to cause severe anaphylactic reactions in susceptible adults but that it is rarely seen in children.
They report on the case of a seven-year-old boy who developed a grade III anaphylactic reaction after eating a cake that contained buckwheat flour. Prior to this incident, the boy had experienced severe allergic reactions to hazelnuts and suffered from an oral allergy syndrome to poppy seed. IgE testing confirmed that the boy was allergic to buckwheat.
The authors note that they found some cross reactivity with certain globulins in buckwheat, poppy seeds and hazelnuts so that whilst the foods are not botanically related there is a potential risk of allergies arising to all three foods in one individual.
Varga EM, Kollmann D, Zach M, Bohle B. Anaphylaxis to Buckwheat in an Atopic Child: A Risk Factor for Severe Allergy to Nuts and Seeds?
Int Arch Allergy Immunol. 2011 Mar 30;156(1):112-116.
Int Arch Allergy Immunol. 2011 Mar 30;156(1):112-116.
Calcium propionate
Calcium propionate is a very commonly used food additive in bread - its primary role is to act as a preservative. Dengate and Ruben carried out a study with in which some children with behaviour problems were found to have certain conditions worsened by calcium propionate.
The conditions that worsened were:
- Irritability
- Restlessness
- Inattention, and
- Sleep disturbance.
Controlled trial of cumulative behavioural effects of a common bread preservative. Dengate S, Ruben A. J Paediatr Child Health 2002;38(4):373-6.
Histamine Restricted Diet
The outcome of a 4 week histamine restricted diet with 44 individuals suffering from 'idiopathic' urticaria, angioedema and pruritus found that 61.4% reported significant improvement and 18.2% reported some improvement.
Other symptoms such as migraines and panic attacks were also alleviated for some of the participants. As the study was not of the type favoured by scientists (i.e. double blind) the authors are reluctant to draw any conclusions other than that the results suggest that this type of restricted diet may be of benefit in some cases.
Outcome of a Histamine-restricted Diet Based on Chart Audit. Joneja, JM ,Carmona-Silva C. J Nut Env Med 2001;11(4).
Iodine Allergy
Kubota et al reported on the case of a 60 year old Japanese woman who suffered from an iodine allergy induced by food containing iodine. She had regularly eaten seaweed since childhood and, from about the age of 30, had experienced severe itching of the skin after consuming iodine-containing foods.
The condition appeared several hours after eating iodine containing food and was not present when iodine rich foods were avoided. She also experienced thyroid dysfunction which was rectified one iodine rich foods were avoided.
Iodine allergy induced by the oral consumption of iodine-containing food. Y Kubota, T Koga, H Miyahara, H Kiryu, J Nakayama
XVII International Congress of Allergology and Clinical Immunology - ICACI XVII Sydney, 2000.
XVII International Congress of Allergology and Clinical Immunology - ICACI XVII Sydney, 2000.
Kissing and Allergies
In cases of extreme allergy a kiss from someone who has recently eaten the food you are allergic to can lead to severe reactions. Monti et al describe the case of a child allergic to fish who reacted with facial urticaria and angioedema after a kiss.
Kiss-induced facial urticaria and angioedema in a child allergic to fish. Monti G, Bonfante G, Muratore MC, Peltran A, Oggero R, Silvestro L, Mussa GC. Allergy 2003;58(7):684-5.
Oral Allergy Syndrome and Figs
To date there have been few reported cases of fig allergy. Those that have been reported have been linked with cross-sensitisation to weeping fig or to the 'latex-fruit.
The authors of this study found that Oral Allergy Syndrome to fig followed by respiratory symptoms can be present in individuals not sensitised to weeping fig or having the latex-fruit syndrome. They confirm that different parts of the fig can have different allergenicities and call for improved commercial fig extracts to be used for the diagnosis of this type of allergy.
Oral allergy syndrome to fig. Antico A, Zoccatelli G, Marcotulli C, Curioni A. Int Arch Allergy Immunol. 2003 Jul;131(2):138-42.
Pancake Syndrome (Oral Mite Anaphylaxis)
"Oral mite anaphylaxis” is a syndrome characterized by severe allergic reactions after the intake of foods made with mite-contaminated wheat flour in susceptible individuals.
Sánchez-Borges et al note that this syndrome is observed more frequently in tropical/subtropical environments. It is often triggered by pancakes and for that reason it has been designated “pancake syndrome”.
Because cooked foods are able to induce the symptoms, it has been proposed that heat resistant allergens are involved in its production. To prevent mite proliferation and the production of anaphylaxis, it has been recommended that wheat flour be stored at low temperatures in the refrigerator.
Sánchez-Borges, Mario MD; Suárez-Chacon, Raúl MD; Capriles-Hulett, Arnaldo MD; Caballero-Fonseca, Fernan MD; Iraola, Victor PhD; Fernández-Caldas, Enrique PhD. Pancake Syndrome (Oral Mite Anaphylaxis). World Allergy Organization Journal: 2009, Volume 2, Issue 5, pp 91-96.
Shiitake Mushrooms
The authors of this French study note that shitake mushrooms are the second most eaten mushroom in the world. Apparently, in Asia, toxic adverse effects due to picking or consumption of shiitake mushrooms are well-known. As consumption of these mushrooms is increasing in the West there is concern that a similar pattern may emerge.
They outline the case of a seventy eight year old woman who experienced an extensive rash, diagnosed as dermatitis, all over her body including her face and scalp. The rash appeared two days after she had eaten a large amount of raw shitake mushrooms.
Shiitake dermatitis now occurs in France. Herault M, Waton J, Bursztejn AC, Schmutz JL, Barbaud A. Ann Dermatol Venereol 2010 Apr;137(4):290-293
Pepper Allergy
A report by Gimenez and Zacharisen describes the case of a 17 month old boy who developed who developed urticaria, conjunctivitis, facial swelling, and severe cough immediately after eating venison prepared in a marinade that contained a number of spices including black and cayenne pepper.
The food that the child was usually given did not contain spices. Skin prick tests were carried to a range of spices with positive results for both cayenne and black pepper extracts.
Severe pepper allergy in a young child. Gimenez L, Zacharisen M. WMJ. 2011 Jun;110(3):138-9.
Spirulina Allergy
Spirulina is a microscopic blue-green algae, a single celled organism, that has been part of the diet of many people in the world. More recently it has become identified, in the west, as a 'superfood' which has led to an increase in its consumption. It has also become commonly used as a food supplement.
In France, Petrus et al, believe that they have identified the first case of an allergic reaction to Spirulina. A thirteen year old boy had a serious episode of urticaria and asthma after swallowing five Spirulina tablets. Allergy tests confirmed that the substance the boy had reacted to was Spirulina.
First case of allergy to spiruline in a 13-year-old child. Petrus M, Assih L, Horen B, Lapebie P, Trigatti A, Culerrier R, Barre A, Rouge P, Dutau G. Revue Française d'Allergologie 2010;50(5):470-472.
Sunflower and Pumpkin seed allergy in children
Caubet et al describe three cases of severe snack seeds allergy in children:
- A 6 year old girl experienced oral itching, swelling of the lips and face, vomiting, and breathing problems within 5 min after eating a handful of sunflower seeds.
- An 11 year old boy experienced an anaphylactic reaction within a few minutes after eating pumpkin seeds.
- A 7 year old boy experienced two episodes of generalized urticaria and facial swelling and a third episode with angioedema, wheezing, and acute breathing difficulties within 15 min after repeatedly consuming small amounts of sunflower seeds.
Caubet JC, Hofer MF, Eigenmann PA, Wassenberg J. Snack seeds allergy in children. Allergy 2010 Jan;65(1):136-7.