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Beriziky P, Cherkaoui M, Linxe L, Perrin E, Rogniaux H, Denery-Papini S, Morisset M, Larré C, Dijk W. Hemp seed: An allergen source with potential cross-reactivity to hazelnut. Food Res Int 2023; 169:112932. [PMID: 37254358 DOI: 10.1016/j.foodres.2023.112932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023]
Abstract
The increasing exposure of the population to Cannabis sativa has revealed allergies to different parts of the plant, among which hemp seed. Nonetheless, the major hemp seed allergens remain to be identified. Several known families of allergens are present in hemp seed, including notably seed storage proteins. We therefore aimed to investigate the potential allergenicity of the hemp seed storage proteins and their potential cross-reactivity to different seeds and nuts. For this, we extracted hemp seed proteins sequentially using buffers with increasing levels of salinity (H2O, T2 and T3) to yield extracts differentially enriched in storage proteins. We used these extracts to perform immunoblots and ELISAs using sera of patients either sensitized to hemp seeds or sensitized/allergic to other seeds and nuts. Immunoblots and proteomics analyses identified vicilins and edestins as potential hemp seed allergens. Moreover, ELISA analyses revealed a correlation between sensitization to hazelnut and the hemp seed T3 extract (enriched in storage proteins). The possible cross-reactivity between hazelnut and hemp seed proteins was further strengthened by the results from inhibition ELISAs: the incubation of sera from hazelnut-sensitized individuals with increasing concentrations of the T3 extract inhibited serum IgE binding to the hazelnut extract by about 25-30%. Our study thus identifies vicilins and edestins as potential hemp seed allergens and highlights a possible cross-reactivity with hazelnut. The clinical relevance of this cross-reactivity between hemp seed and hazelnut needs to be further investigated in hazelnut-allergic individuals.
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Affiliation(s)
- Princy Beriziky
- INRAE, UR BIA, F-44316, Nantes, France; CHU d'Angers, unité d'allergologie, Angers, France
| | - Mehdi Cherkaoui
- INRAE, UR BIA, F-44316, Nantes, France; INRAE, PROBE research infrastructure, BIBS Facility, F-44316 Nantes, France
| | | | | | - Hélène Rogniaux
- INRAE, UR BIA, F-44316, Nantes, France; INRAE, PROBE research infrastructure, BIBS Facility, F-44316 Nantes, France
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2
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Toscano A, Elst J, van der Poorten ML, Beyens M, Heremans K, Decuyper II, Van Gasse AL, Mertens C, Van Houdt M, Hagendorens MM, Sabato V, Ebo DG. Establishing diagnostic strategies for cannabis allergy. Expert Rev Clin Immunol 2022; 18:1015-1022. [PMID: 35912836 DOI: 10.1080/1744666x.2022.2108791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cannabis is the most widely consumed illicit drug in the world and carries a risk of severe IgE-mediated allergic reactions, requiring appropriate diagnostic management. Currently available diagnostics are still relatively limited and require careful interpretation of results to avoid harmful over- and underdiagnosis. AREAS COVERED This review focuses on the most up-to-date understandings of cannabis allergy diagnosis, starting with the main clinical features of the disease and the allergenic characteristics of Cannabis sativa, and then providing insights into in vivo, in vitro, and ex vivo diagnostic tests. EXPERT OPINION At present, the diagnosis of IgE-mediated cannabis allergy is based on a three-step approach that starts with accurate history taking and ends with a confirmation of sensitization to the whole extract and, finally, molecular components. Although much has been discovered since its first description in 1971, the diagnosis of cannabis allergy still has many unmet needs. The lack of commercial standardized and validated extracts and in vitro assays makes a harmonized workup of cannabis allergy difficult. Furthermore, the epidemiological characteristics, and clinical implications of sensitization to different molecular components are not yet fully known. Future research will complete the picture and likely result in an individualized and standardized approach.
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Affiliation(s)
- Alessandro Toscano
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Post-Graduate School of Allergology and Clinical Immunology, University of Milan, Milan, Italy
| | - Jessy Elst
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Marie-Line van der Poorten
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Michiel Beyens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Kevin Heremans
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Ine I Decuyper
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Athina L Van Gasse
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Christel Mertens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Michel Van Houdt
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
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3
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Orozco FR, Lin M, Hur K. Cannabis Use and Sinonasal Symptoms in US Adults. JAMA Otolaryngol Head Neck Surg 2022; 148:854-861. [PMID: 35900733 PMCID: PMC9335247 DOI: 10.1001/jamaoto.2022.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Cannabis is the most commonly used illicit substance in the US and worldwide. Understanding the association between cannabis use and sinonasal symptoms may help clinicians and patients better understand the symptomatology associated with cannabis use. Objective To assess the association between frequency of cannabis use and presence of sinonasal symptoms in a nationally representative sample of US adults. Design, Setting, and Participants This population-based, retrospective cross-sectional study included adults aged 20 to 69 years who had completed data on sinonasal symptoms and substance use for the 2013 to 2014 National Health and Nutrition Examination Survey. The data were analyzed in February 2022. Exposures Cannabis use frequency. Main Outcomes and Measures Presence of sinonasal symptoms, demographic information, and medical history were obtained from National Health and Nutrition Examination Survey questionnaires. Presence of any sinonasal symptoms was defined as responding yes to any of a series of questions assessing rhinologic symptoms. Regular cannabis users were defined as using cannabis 15 or more times within the last 30 days. Nonregular users were defined as using cannabis fewer than 15 times within the last 30 days. Multivariable models were used to examine the association between frequency of cannabis use and presence of sinonasal symptoms while adjusting for demographic characteristics and medical comorbidities. Results The study included 2269 adults with a mean (SD) age of 36.5 (12.4) years (1207 women [53.2%]; 330 Asian [14.5%], 739 Black [32.6%], 461 Hispanic [20.3%], and 656 White [28.9%] individuals). The prevalence of sinonasal symptoms among regular cannabis users (45.0%; 95% Cl, 38.9%-51.1%) was lower than the prevalence among never users (64.5%; 95% Cl, 58.3%-68.8%). Compared with adults who had never used cannabis, regular cannabis users were less likely to have sinonasal symptoms (odds ratio, 0.22, 95% CI, 0.10-0.50). Current tobacco smokers were more likely to have sinonasal symptoms (odds ratio, 1.96; 95% CI, 1.17-3.28). The most common sinonasal symptoms reported were nasal congestion (62.8%; 95% Cl, 60.2%-65.4%) and change in smell (17.8%; 95% Cl, 15.2%-20.9%). Conclusions and Relevance This cross-sectional study found that the prevalence of sinonasal symptoms was lower among regular cannabis users. Further research is needed to elucidate the mechanisms underlying the association between cannabis use and sinonasal symptoms.
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Affiliation(s)
| | - Matthew Lin
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Kevin Hur
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles
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Abstract
BACKGROUND Cannabis has been rapidly legalized in North America; however, limited evidence exists around its side effects. Health Canada defines side effect as a harmful and unintended response to a health product. Given drug safety concerns, this study's purpose was to review the unintended side effects of cannabis in otolaryngology. METHODS The Preferred Reporting Items For Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the MEDLINE, EMBASE, CINAHL, and CENTRAL databases. (PROSPERO: CRD42020153022). English studies in adults were included from inception to the end of 2019. In-vitro, animal, and studies with n < 5 were excluded. Primary outcome was defined as unintended side effects (defined as any Otolaryngology symptom or diagnosis) following cannabis use. Oxford Centre for Evidence-Based Medicine: Levels of Evidence and risk of bias using the Risk of Bias in randomized trials (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tools were assessed.. Two authors independently reviewed all studies; the senior author settled any discrepancies. RESULTS Five hundred and twenty-one studies were screened; 48 studies were analysed. Subspecialties comprised: Head and Neck (32), Otology (8), Rhinology (5), Airway (5), Laryngology (1). Cannabis use was associated with unintended tinnitus, vertigo, hearing loss, infection, malignancy, sinusitis, allergic rhinitis, thyroid dysfunction, and dyspnea. About half (54.1%) of studies showed increased side effects, or no change in symptoms following cannabis use. Oxford Levels of Evidence was 2-4 with substantial heterogeneity. Risk of bias assessment with RoB2 was low to high and ROBINS-1 was moderate to critical. CONCLUSION This was the first comprehensive scoping review of unintended side effects of cannabis in Otolaryngology. The current literature is limited and lacks high-quality research Future randomized studies are needed to focus on therapeutic effects of cannabis in otolaryngology. Substantial work remains to guide clinicians to suggest safe, evidence-based choices for cannabis use.
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Affiliation(s)
- Jobanjit S Phulka
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, 4th Floor, Gordon and Leslie Diamond Health Care Center, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z1M9, Canada
| | - Joel W Howlett
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, 4th Floor, Gordon and Leslie Diamond Health Care Center, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z1M9, Canada.
| | - Amanda Hu
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, 4th Floor, Gordon and Leslie Diamond Health Care Center, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z1M9, Canada
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5
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Decuyper II, Green BJ, Sussman GL, Ebo DG, Silvers WS, Pacheco K, King BS, Cohn JR, Zeiger RS, Zeiger JS, Naimi DR, Beezhold DH, Nayak AP. Occupational Allergies to Cannabis. J Allergy Clin Immunol Pract 2021; 8:3331-3338. [PMID: 33161961 DOI: 10.1016/j.jaip.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Within the last decade there has been a significant expansion in access to cannabis for medicinal and adult nonmedical use in the United States and abroad. This has resulted in a rapidly growing and diverse workforce that is involved with the growth, cultivation, handling, and dispensing of the cannabis plant and its products. The objective of this review was to educate physicians on the complexities associated with the health effects of cannabis exposure, the nature of these exposures, and the future practical challenges of managing these in the context of allergic disease. We will detail the biological hazards related to typical modern cannabis industry operations that may potentially drive allergic sensitization in workers. We will highlight the limitations that have hindered the development of objective diagnostic measures that are essential in separating "true" cannabis allergies from nonspecific reactions/irritations that "mimic" allergy-like symptoms. Finally, we will discuss recent advances in the basic and translational scientific research that will aid the development of diagnostic tools and therapeutic standards to serve optimal management of cannabis allergies across the occupational spectrum.
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Affiliation(s)
- Ine I Decuyper
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence University of Antwerp, Antwerp, Belgium
| | - Brett J Green
- Office of the Director, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, Wv
| | - Gordon L Sussman
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Didier G Ebo
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; Infla-Med Centre of Excellence University of Antwerp, Antwerp, Belgium
| | | | - Karin Pacheco
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colo
| | - Bradley S King
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, Colo
| | - John R Cohn
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, Pa; Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa
| | | | | | | | - Donald H Beezhold
- Office of the Director, Health Effects Laboratory Division, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, Wv
| | - Ajay P Nayak
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, Pa; Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa; Center for Translational Medicine, Thomas Jefferson University, Philadelphia, Pa.
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6
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Wenger JP, Dabney CJ, ElSohly MA, Chandra S, Radwan MM, Majumdar CG, Weiblen GD. Validating a predictive model of cannabinoid inheritance with feral, clinical, and industrial Cannabis sativa. Am J Bot 2020; 107:1423-1432. [PMID: 33103246 PMCID: PMC7702092 DOI: 10.1002/ajb2.1550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/29/2020] [Indexed: 05/21/2023]
Abstract
PREMISE How genetic variation within a species affects phytochemical composition is a fundamental question in botany. The ratio of two specialized metabolites in Cannabis sativa, tetrahydrocannabinol (THC) and cannabidiol (CBD), can be grouped into three main classes (THC-type, CBD-type, and intermediate type). We tested a genetic model associating these three groups with functional and nonfunctional alleles of the cannabidiolic acid synthase gene (CBDAS). METHODS We characterized cannabinoid content and assayed CBDAS genotypes of >300 feral C. sativa plants in Minnesota, United States. We performed a test cross to assess CBDAS inheritance. Twenty clinical cultivars obtained blindly from the National Institute on Drug Abuse and 12 Canadian-certified grain cultivars were also examined. RESULTS Frequencies of CBD-type, intermediate-type, and THC-type feral plants were 0.88, 0.11, and 0.01, respectively. Although total cannabinoid content varied substantially, the three groupings were perfectly correlated with CBDAS genotypes. Genotype frequencies observed in the test cross were consistent with codominant Mendelian inheritance of the THC:CBD ratio. Despite significant mean differences in total cannabinoid content, CBDAS genotypes blindly predicted the THC:CBD ratio among clinical cultivars, and the same was true for industrial grain cultivars when plants exhibited >0.5% total cannabinoid content. CONCLUSIONS Our results extend the generality of the inheritance model for THC:CBD to diverse C. sativa accessions and demonstrate that CBDAS genotyping can predict the ratio in a variety of practical applications. Cannabinoid profiles and associated CBDAS segregation patterns suggest that feral C. sativa populations are potentially valuable experimental systems and sources of germplasm.
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Affiliation(s)
- Jonathan P. Wenger
- Department of Plant & Microbial BiologyUniversity of MinnesotaSaint PaulMN55108USA
| | - Clemon J. Dabney
- Department of Plant & Microbial BiologyUniversity of MinnesotaSaint PaulMN55108USA
| | - Mahmoud A. ElSohly
- Department of Pharmaceutics and Drug DeliverySchool of PharmacyUniversity of MississippiUniversityMS38677USA
- National Center for Natural Products ResearchResearch Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMS38677USA
| | - Suman Chandra
- National Center for Natural Products ResearchResearch Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMS38677USA
| | - Mohamed M. Radwan
- National Center for Natural Products ResearchResearch Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMS38677USA
| | - Chandrani G. Majumdar
- National Center for Natural Products ResearchResearch Institute of Pharmaceutical SciencesSchool of PharmacyUniversity of MississippiUniversityMS38677USA
| | - George D. Weiblen
- Department of Plant & Microbial BiologyUniversity of MinnesotaSaint PaulMN55108USA
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Jackson B, Cleto E, Jeimy S. An emerging allergen: Cannabis sativa allergy in a climate of recent legalization. Allergy Asthma Clin Immunol 2020; 16:53. [PMID: 32834822 PMCID: PMC7371810 DOI: 10.1186/s13223-020-00447-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
Considering its recent legalization in Canada, the health implications of Cannabis sativa exposure, including allergy, are coming to the forefront of medical study and interest. C. sativa allergy is an issue that affects recreational users of the substance, processors, agricultural workers, and contacts of Cannabis aeroallergens and secondhand product. Allergies to C. sativa are heterogenous and span the spectrum of hypersensitivity, from dermatitis to rhinoconjunctivitis to life-threatening anaphylaxis. Due to its recent legalization, sensitized individuals will have increasing exposure from direct contact to agricultural pollens. Diagnosis and treatment of Cannabis allergy are developing fields that are already showing promise in the identification of culprit antigens and the potential for immunotherapy; however, much responsibility still falls on clinical diagnosis and symptom management. Hopefully, given the current explosion of interest in and use of Cannabis, C. sativa allergy will continue to garner awareness and therapeutic strategies.
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Affiliation(s)
- Bradley Jackson
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, London, ON Canada
| | - Erica Cleto
- Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada.,B3-112, St. Joseph's Healthcare London, 268 Grosvenor Street, London, ON N6A 4V2 Canada
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8
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Decuyper II, Rihs HP, Van Gasse AL, Elst J, De Puysseleyr L, Faber MA, Mertens C, Hagendorens MM, Sabato V, Bridts C, De Clerck L, Ebo DG. Cannabis allergy: what the clinician needs to know in 2019. Expert Rev Clin Immunol 2019; 15:599-606. [DOI: 10.1080/1744666x.2019.1600403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ine Ilona Decuyper
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Hans-Peter Rihs
- IPA—Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum, Bochum, Germany
| | - Athina Ludovica Van Gasse
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jessy Elst
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Leander De Puysseleyr
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Margaretha Antje Faber
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Christel Mertens
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Margo Maria Hagendorens
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Chris Bridts
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Luc De Clerck
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Didier Gaston Ebo
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Silvers WS, Bernard T. Spectrum and prevalence of reactions to marijuana in a Colorado allergy practice. Ann Allergy Asthma Immunol 2018; 119:570-571. [PMID: 29223301 DOI: 10.1016/j.anai.2017.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022]
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10
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Davidson M, Reed S, Oosthuizen J, O’Donnell G, Gaur P, Cross M, Dennis G. Occupational health and safety in cannabis production: an Australian perspective. Int J Occup Environ Health 2018; 24:75-85. [PMID: 30281413 PMCID: PMC6237171 DOI: 10.1080/10773525.2018.1517234] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/25/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
The legal Australian cannabis industry has been rapidly expanding due to increased awareness of the plant's therapeutic potential, as well its diverse range of applications including biofuel, textiles, building materials, food, nutritional supplement, and animal feed. The objective of this paper is to describe the current landscape of the commercial Australian cannabis industry, summarise occupational health and safety (OHS) hazards in cannabis-related working environments, and provide suggestions for safeguarding worker health and well-being in this emerging industry. A comprehensive search of peer-reviewed and grey literature published between 1900 and 2017 was undertaken to identify case studies and original epidemiological research on OHS hazards associated with the cannabis cultivation and the manufacture of cannabis-based products. The review found that the majority of OHS studies were undertaken in the hemp textile industry during the late twentieth century, with a small number of articles published from a variety of occupational environments including forensic laboratories and recreational marijuana farms. Cannabis harvesting and initial processing is labour intensive, and presents a physical hazard Depending on the operation, workers may also be exposed to a variety of biological, chemical, and physical hazards including: organic dusts, bioaerosols, pollen/allergens, volatile organic compounds, psychoactive substances (tetrahydrocannabinol [THC])), noise, and ultraviolet radiation. Little research has been undertaken on the exposure to inhalable organic dust and other bioaerosols during the commercial cultivation and manufacture of cannabis-based products. Furthermore, there is an absence of Australian-based research and OHS guidance materials to help professionals develop risk management strategies in this evolving industry. It is recommended that: Investigation into the toxicological properties of cannabis dusts, specifically in relation to potential occupational exposures during cultivation and manufacture, should be a priority. The interim adoption of the respirable cotton dust exposure standard of 0.2 mg/m3 for workplace exposure in hemp facilities until a cannabis workplace exposure standard is developed, and that exposure to medicinal cannabis containing THC are kept as low as reasonably practicable. An industry partnership be established for the development of an Australian health and safety guideline for the production of medicinal cannabis and hemp. A classification to meet the requirements of the Global Harmonization Scheme should be undertaken to ensure consistency in the use of safety and risk phrases in cannabis-related industries.
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Affiliation(s)
- Maggie Davidson
- School of Science and Health, Western Sydney University, Sydney, Australia
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Sue Reed
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jacques Oosthuizen
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Greg O’Donnell
- Test Safe Analytical Services, Safe Work NSW, Sydney, Australia
| | - Pragna Gaur
- Illicit Drugs Analysis Unit, Forensics Analytical Science Services, Sydney, Australia
| | - Martyn Cross
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Gary Dennis
- School of Science and Health, Western Sydney University, Sydney, Australia
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Abstract
The plant and mushroom kingdoms have species used for intoxication, inebriation, or recreation. Some of these species are toxic. Given that many of these plants or substances are illegal and have histories of abuse, much of the research regarding therapeutic application is based on basic science, animal studies, and traditional use. This review examines Cannabis, Euphorbia, Ricinus, Podophyllum, Veratrum, mushrooms, and nightshades, along with resveratrol and cocaine as they relate to dermatology.
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Affiliation(s)
- Deeptej Singh
- Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Juliya Fisher
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Devorah Shagalov
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Aakaash Varma
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Daniel M Siegel
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
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Bhatia P, Chen M, Christiansen S. Marijuana and stoned fruit. Ann Allergy Asthma Immunol 2018; 120:536-537. [PMID: 29410115 DOI: 10.1016/j.anai.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Prerana Bhatia
- Department of Medicine, University of California-San Diego, San Diego, California.
| | - Meng Chen
- Department of Medicine, University of California-San Diego, San Diego, California
| | - Sandra Christiansen
- Department of Medicine, University of California-San Diego, San Diego, California
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13
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Abstract
BACKGROUND The recent legalization of marijuana use for both medical and recreational purposes in several states of the United Sates is expected to further increase the already high prevalence of marijuana use. Although allergic reactions are uncommon, the potential of marijuana use and cultivation to cause allergy should be considered. We aimed to investigate whether marijuana use is associated with the prevalence of sensitization to specific allergens. METHODS A total of 2671 adults (aged 20-59 years) who participated in the 2005-2006 National Health and Nutrition Examination Survey were included. Participants completed a questionnaire on marijuana use and underwent sensitization tests to 19 specific allergens. Those who reported marijuana use for at least 1 day in the past 30 days were considered marijuana users. RESULTS No difference was found in the history of allergy between marijuana users and non-users. Compared with marijuana non-users as a reference group, the adjusted odds ratio (AOR) of sensitization to a specific allergen among marijuana users was significantly greater for antibodies against the following: Alternaria alternata (AOR=1.67; 95% confidence interval (CI), 1.04-2.70), D. farinae (AOR=1.68; 95% CI, 1.27-2.22), D. pteronyssin (AOR=1.65; 95% CI, 1.32-2.06), ragweed (AOR=1.84; 95% CI, 1.30-2.59), rye grass (AOR=1.49; 95% CI, 1.12-1.97), Bermuda grass (AOR=1.55; 95% CI, 1.03-2.33), oak (AOR=1.76; 95% CI, 1.14-2.70), birch (AOR=2.09; 95% CI, 1.23-3.55), peanut (AOR=1.91; 95% CI, 1.25-2.92), and cat dander (AOR=1.51; 95% CI=1.13-2.03). CONCLUSIONS We provide preliminary findings to suggest that marijuana use is associated with sensitization to specific allergens, including molds, dust mites, plants, and cat dander.
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Affiliation(s)
- Jin-Young Min
- Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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Drouet M, Hoppe A, Moreau AS, Bonneau JC, Leclere JM, Le Sellin J. [Cannabis and crossed allergy with food]. Rev Pneumol Clin 2017; 73:290-293. [PMID: 29122396 DOI: 10.1016/j.pneumo.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
Cannabis use has increased over the last decade. At the same time, we see cannabis allergies appearing, ranging from simple rhinoconjunctivitis to anaphylactic-type reactions, some of which are severe since fatal cases have been described, but we also see allergic-induced food allergies cross-linked in the family of lipid transfer proteins (LTP). Indeed, cannabis contains an LTP called Can s 3. The LT are very widespread in the vegetable kingdom and are present in many vegetables and fruits. LTPs have a similar chemical structure and therefore cross-allergy is common. Thus, by becoming aware of the LTP of cannabis, it is possible to become allergic by a mechanism of cross-allergy to the other LTPs present in fruits and vegetables. This syndrome is referred to as cannabis-fruit-vegetable syndrome.
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Affiliation(s)
- M Drouet
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France.
| | - A Hoppe
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
| | - A S Moreau
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
| | - J C Bonneau
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
| | - J M Leclere
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
| | - J Le Sellin
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
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Decuyper II, Van Gasse AL, Cop N, Sabato V, Faber MA, Mertens C, Bridts CH, Hagendorens MM, De Clerck L, Rihs HP, Ebo DG. Cannabis sativa allergy: looking through the fog. Allergy 2017; 72:201-206. [PMID: 27590896 DOI: 10.1111/all.13043] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/28/2022]
Abstract
IgE-mediated Cannabis (C. sativa, marihuana) allergy seems to be on the rise. Both active and passive exposure to cannabis allergens may trigger a C. sativa sensitization and/or allergy. The clinical presentation of a C. sativa allergy varies from mild to life-threatening reactions and often seems to depend on the route of exposure. In addition, sensitization to cannabis allergens can result in various cross-allergies, mostly for plant foods. This clinical entity, designated as the 'cannabis-fruit/vegetable syndrome', might also imply cross-reactivity with tobacco, natural latex and plant-food-derived alcoholic beverages. Hitherto, these cross-allergies are predominantly reported in Europe and appear mainly to rely upon cross-reactivity between nonspecific lipid transfer proteins or thaumatin-like proteins present in C. sativa and their homologues, ubiquitously distributed throughout plant kingdom. At present, diagnosis of cannabis-related allergies predominantly rests upon a thorough history completed with skin testing using native extracts from crushed buds and leaves. However, quantification of specific IgE antibodies and basophil activation tests can also be helpful to establish correct diagnosis. In the absence of a cure, treatment comprises absolute avoidance measures. Whether avoidance of further use will halt the extension of related cross-allergies remains uncertain.
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Affiliation(s)
- I. I. Decuyper
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
- Department of Pediatrics; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - A. L. Van Gasse
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
- Department of Pediatrics; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - N. Cop
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - V. Sabato
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - M. A. Faber
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - C. Mertens
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - C. H. Bridts
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - M. M. Hagendorens
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
- Department of Pediatrics; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - L. De Clerck
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - H. P. Rihs
- Institute for Prevention and Occupational Medicine; German Social Accident Insurance; Ruhr-University Bochum; Bochum Germany
| | - D. G. Ebo
- Department of Immunology, Allergology, and Rheumatology Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
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Omidi A, Sauvage C, Vandezande L, Wallaert B. La LTP du cannabis : une voie de sensibilisation aux LTP alimentaires. Revue Française d'Allergologie 2015. [DOI: 10.1016/j.reval.2015.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Decuyper I, Ryckebosch H, Van Gasse AL, Sabato V, Faber M, Bridts CH, Ebo DG. Cannabis Allergy: What do We Know Anno 2015. Arch Immunol Ther Exp (Warsz) 2015; 63:327-32. [PMID: 26178655 DOI: 10.1007/s00005-015-0352-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
For about a decade, IgE-mediated cannabis (marihuana) allergy seems to be on the rise. Both active and passive exposure to cannabis allergens may lead to a cannabis sensitization and/or allergy. The clinical manifestations of a cannabis allergy can vary from mild to life-threatening reactions, often depending on the route of exposure. In addition, sensitization to cannabis allergens can trigger various secondary cross-allergies, mostly for plant-derived food. This clinical entity, which we have designated as the "cannabis-fruit/vegetable syndrome" might also imply cross-reactivity with tobacco, latex and plant-food derived alcoholic beverages. These secondary cross-allergies are mainly described in Europe and appear to result from cross-reactivity between non-specific lipid transfer proteins or thaumatin-like proteins present in Cannabis sativa and their homologues that are ubiquitously distributed throughout plant kingdom. At present, diagnosis of cannabis-related allergies rests upon a thorough history completed with skin testing using native extracts from buds and leaves. However, quantification of specific IgE antibodies and basophil activation tests can also be helpful to establish correct diagnosis. In the absence of a cure, treatment comprises absolute avoidance measures including a stop of any further cannabis (ab)use.
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Ocampo TL, Rans TS. Cannabis sativa: the unconventional "weed" allergen. Ann Allergy Asthma Immunol 2015; 114:187-92. [PMID: 25744904 DOI: 10.1016/j.anai.2015.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/15/2015] [Accepted: 01/15/2015] [Indexed: 11/24/2022]
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Swerts S, Van Gasse A, Leysen J, Faber M, Sabato V, Bridts CH, Jorens PG, De Clerck LS, Ebo DG. Allergy to illicit drugs and narcotics. Clin Exp Allergy 2014; 44:307-18. [DOI: 10.1111/cea.12177] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/30/2013] [Accepted: 07/12/2013] [Indexed: 12/13/2022]
Affiliation(s)
- S. Swerts
- Faculty of Medicine and Health Science; Department of Immunology, Allergology and Rheumatology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
| | - A. Van Gasse
- Faculty of Medicine and Health Science; Department of Immunology, Allergology and Rheumatology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
| | - J. Leysen
- Faculty of Medicine and Health Science; Department of Immunology, Allergology and Rheumatology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
| | - M. Faber
- Faculty of Medicine and Health Science; Department of Immunology, Allergology and Rheumatology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
| | - V. Sabato
- Faculty of Medicine and Health Science; Department of Immunology, Allergology and Rheumatology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
| | - C. H. Bridts
- Faculty of Medicine and Health Science; Department of Immunology, Allergology and Rheumatology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
| | - P. G. Jorens
- Faculty of Medicine and Health Science; Department of Clinical Pharmacology/Toxicology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
| | - L. S. De Clerck
- Faculty of Medicine and Health Science; Department of Immunology, Allergology and Rheumatology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
| | - D. G. Ebo
- Faculty of Medicine and Health Science; Department of Immunology, Allergology and Rheumatology; University Antwerp and Antwerp University Hospital; Antwerpen Belgium
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Abstract
With the advent of legalization of marijuana for medicinal and recreational purposes, and the increase use of marijuana, healthcare providers will be increasingly confronted with marijuana users as patients in clinical environments. While there is vast literature regarding the societal and mental health harms associated with marijuana use, there is a paucity of reviews of the potential consequences of marijuana use on physical health or medical conditions. We examine the recent literature on the physical harms associated with illicit and legal marijuana administration. We surveyed the peer-reviewed medical literature from 1998 to 2013 of studies assessing the association of marijuana use and physical diseases. We conclude that healthcare providers should be cognizant that the existing literature suggests that marijuana use can cause physical harm. However, evidence is needed, and further research should be considered, to prove causal associations of marijuana with many physical health conditions.
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Affiliation(s)
- Adam J Gordon
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, 151-C, University Drive C, Pittsburgh, PA, 15240-1001, USA,
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21
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Larramendi CH, López-Matas MÁ, Ferrer A, Huertas AJ, Pagán JA, Navarro LÁ, García-Abujeta JL, Andreu C, Carnés J. Prevalence of sensitization to Cannabis sativa. Lipid-transfer and thaumatin-like proteins are relevant allergens. Int Arch Allergy Immunol 2013; 162:115-22. [PMID: 23921252 DOI: 10.1159/000351068] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 03/27/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although allergy to Cannabis sativa was first reported over 40 years ago, the allergenicity has scarcely been studied. The objectives of this study were to investigate the frequency of sensitization to this plant, to analyze the clinical characteristics and allergenic profile of sensitized individuals and to identify the allergens involved. METHODS Five hundred and forty-five individuals in Spain attending allergy clinics with respiratory or cutaneous symptoms underwent a skin-prick test (SPT) with C. sativa leaf extract. The extract was characterized by SDS-PAGE and 2-dimensional electrophoresis. Specific IgE to C. sativa was measured in positive SPT individuals. The clinical and allergenic profiles of sensitized individuals were investigated and the most-recognized allergens sequenced and characterized by liquid chromatography-mass spectrometry/mass spectrometry. RESULTS Of this preselected population, 44 individuals had positive SPT to C. sativa (prevalence 8.1%). Prevalence was higher in individuals who were C. sativa smokers (14.6%). Two individuals reported mild symptoms with C. sativa. Twenty-one individuals from 32 available sera (65.6%) had positive specific IgE to C. sativa. Twelve sera recognized at least 6 different bands in a molecular-weight range of between 10 and 60 kDa. Six of them recognized a 10-kDa band, identified as a lipid transfer protein (LTP) and 8 recognized a 38-kDa band, identified as a thaumatin-like protein. CONCLUSIONS There is a high prevalence of sensitization to C. sativa leaves. The clinical symptoms directly attributed to C. sativa were uncommon and mild. The sensitization profile observed suggests that C. sativa sensitization may be mediated by two mechanisms, i.e. cross-reactivity, mainly with LTP and thaumatin-like protein, and exposure-related 'de novo' sensitization.
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Affiliation(s)
- Carlos H Larramendi
- Allergy Section, Hospital Marina Baixa, Villajoyosa and Centro de Especialidades Foietes, Benidorm, Spain
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Nayak AP, Green BJ, Sussman G, Berlin N, Lata H, Chandra S, ElSohly MA, Hettick JM, Beezhold DH. Characterization of Cannabis sativa allergens. Ann Allergy Asthma Immunol 2013; 111:32-7. [PMID: 23806457 PMCID: PMC3726218 DOI: 10.1016/j.anai.2013.04.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 04/17/2013] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Allergic sensitization to Cannabis sativa is rarely reported, but the increasing consumption of marijuana has resulted in an increase in the number of individuals who become sensitized. To date, little is known about the causal allergens associated with C sativa. OBJECTIVE To characterize marijuana allergens in different components of the C sativa plant using serum IgE from marijuana sensitized patients. METHODS Serum samples from 23 patients with a positive skin prick test result to a crude C sativa extract were evaluated. IgE reactivity was variable between patients and C sativa extracts. IgE reactivity to C sativa proteins in Western blots was heterogeneous and ranged from 10 to 70 kDa. Putative allergens derived from 2-dimensional gels were identified. RESULTS Prominent IgE reactive bands included a 23-kDa oxygen-evolving enhancer protein 2 and a 50-kDa protein identified to be the photosynthetic enzyme ribulose-1,5-bisphosphate carboxylase/oxygenase. Additional proteins were identified in the proteomic analysis, including those from adenosine triphosphate synthase, glyceraldehyde-3-phosphate dehydrogenase, phosphoglycerate kinase, and luminal binding protein (heat shock protein 70), suggesting these proteins are potential allergens. Deglycosylation studies helped refine protein allergen identification and demonstrated significant IgE antibodies against plant oligosaccharides that could help explain cross-reactivity. CONCLUSION Identification and characterization of allergens from C sativa may be helpful in further understanding allergic sensitization to this plant species.
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Affiliation(s)
- Ajay P. Nayak
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505
| | - Brett J. Green
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505
| | - Gordon Sussman
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Noam Berlin
- Gordon Sussman Clinical Allergy Research Inc., Toronto, Ontario, Canada
| | - Hemant Lata
- National Center for Natural Product Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, University, MS 38677
| | - Suman Chandra
- National Center for Natural Product Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, University, MS 38677
| | - Mahmoud A. ElSohly
- National Center for Natural Product Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, University, MS 38677
| | - Justin M. Hettick
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505
| | - Donald H. Beezhold
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505
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Herzinger T, Schöpf P, Przybilla B, Ruëff F. IgE-mediated hypersensitivity reactions to cannabis in laboratory personnel. Int Arch Allergy Immunol 2011; 156:423-6. [PMID: 21832832 DOI: 10.1159/000324444] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 01/10/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There have been sporadic reports of hypersensitivity reactions to plants of the Cannabinaceae family (hemp and hops), but it has remained unclear whether these reactions are immunologic or nonimmunologic in nature. OBJECTIVE We examined the IgE-binding and histamine-releasing properties of hashish and marijuana extracts by CAP-FEIA and a basophil histamine release test. METHODS Two workers at a forensic laboratory suffered from nasal congestion, rhinitis, sneezing and asthmatic symptoms upon occupational contact with hashish or marijuana, which they had handled frequently for 25 and 16 years, respectively. Neither patient had a history of atopic disease. Serum was analyzed for specific IgE antibodies to hashish or marijuana extract by research prototype ImmunoCAP, and histamine release from basophils upon exposure to hashish or marijuana extracts was assessed. Results were matched to those of 4 nonatopic and 10 atopic control subjects with no known history of recreational or occupational exposure to marijuana or hashish. RESULTS Patient 1 had specific IgE to both hashish and marijuana (CAP class 2), and patient 2 to marijuana only (CAP class 2). Controls proved negative for specific IgE except for 2 atopic individuals with CAP class 1 to marijuana and 1 other atopic individual with CAP class 1 to hashish. Stimulation of basophils with hashish or marijuana extracts elicited histamine release from basophils of both patients and 4 atopic control subjects. CONCLUSIONS Our results suggest an IgE-related pathomechanism for hypersensitivity reactions to marijuana or hashish.
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Affiliation(s)
- T Herzinger
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, Frauenlobstrasse 9–11, Munich, Germany.
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de Larramendi CH, Carnés J, García-Abujeta JL, García-Endrino A, Muñoz-Palomino E, Huertas AJ, Fernández-Caldas E, Ferrer A. Sensitization and allergy to Cannabis sativa leaves in a population of tomato (Lycopersicon esculentum)-sensitized patients. Int Arch Allergy Immunol 2008; 146:195-202. [PMID: 18268387 DOI: 10.1159/000115887] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 10/30/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cases of allergy to Cannabis sativa have occasionally been reported, but both the allergenic profile and eventual cross-reactivity pattern remain unknown. OBJECTIVE To analyze the allergenic profile of a population of patients from Spain sensitized to C. sativa and to characterize the C. sativa leaf extract. METHODS A total of 32 subjects were enrolled in the study: group A, 10 individuals sensitized to tomato, reporting reactions by contact or inhalation to Cannabis; group B, 14 individuals sensitized to tomato, without reactions to Cannabis; group C, 8 individuals not sensitized to tomato and without reactions to Cannabis. Sensitivity to Cannabis, tomato and peach peel, Platanus hybrida and Artemisia vulgaris pollen extracts was measured by skin tests and specific IgE. Individual immunoblots and inhibition experiments with a pool of sera were conducted. RESULTS All tomato-sensitized subjects (and 1 negative) had positive skin tests to C. sativa leaves and hashish. Specific IgE to C. sativa and peach peel was more common than to tomato. Immunoblot experiments showed 2 prominent bands of 10 and 14 kDa and 2 weakly recognized bands of 30 and 45 kDa. Tomato, peach and A. vulgaris extracts inhibited most of the bands present in C. sativa. P. hybrida inhibited only the high-molecular-weight bands. CONCLUSION Sensitization to C. sativa with or without symptoms is frequent among patients in Spain sensitized to tomato. C. sativa leaves are a potential allergenic source and their allergens may cross-react with other allergenic sources from plants (fruit peels and pollen).
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Affiliation(s)
- Carlos Hernando de Larramendi
- Unidad de Alergia, Hospital Marina Baixa, Villajoyosa (Alicante) and Centro de Especialidades Foietes, Benidorm, Spain.
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Abstract
Respiratory problems or urticaria are well known in patients sensitized to tobacco. This occurs mainly as an occupational disease in tobacco workers, but also occasionally in those who smoke tobacco or dip snuff. Similar respiratory problems and anaphylactoid reactions have been observed in patients sensitized to cannabis. This may occur in those allergic to cannabis pollen when the plants bloom, in those with agricultural exposure and rarely in the end consumer. We describe a patient with generalized itching provoked by tobacco and cannabis smoking. Skin prick tests and specific IgE towards tobacco and cannabis were positive. Because of the close correlation of smoking tobacco or cannabis and the onset of symptoms, we put forward the diagnosis of a type I allergic reaction towards tobacco and cannabis.
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