Contact allergy to thiocolchicoside

An IgE Immediate Reaction to Thiocolchicoside

Hypersensitivity reactions due to muscle relaxant drugs may be related either to a nonspecific release of allergic mediators or to allergic reactions induced by the molecules themselves. Rare cases of hypersensitivity reactions have been associated to thiocolchicoside, and no case of IgE-mediated immediate reaction has actually been reported to date. We report the first documented case of immediate anaphylaxis to thiocolchicoside.

Coriander anaphylaxis in a spice grinder with undetected occupational allergy

BACKGROUND

Anaphylaxis after ingestion of spices as a result from occupational sensitization remains anecdotal. We describe a patient, working in a spice factory, with anaphylaxis from coriander in a meal. He also demonstrated urticaria, angio-edema, rhinoconjunctivitis and bronchospasm during handling coriander and fenugreek.

OBJECTIVE

To determine the mechanism of the anaphylactic reaction and to evaluate cross-reactivity between both botanically unrelated spices.

METHODS

Investigations comprised quantification of total and specific IgE by Immuno-CAP FEIA, skin testing, basophil activation experiments by flow-assisted determination of CD63 expression in the patient and 3 healthy controls. Immuno-CAP inhibition experiments were applied to investigate cross-reactivity.

RESULTS

Specific IgE, skin tests and basophil activation tests were clearly positive in the patient, whereas they remained negative in controls. No cross-reactivity between fenugreek and coriander was demonstrable by inhibition experiments.

CONCLUSIONS

The clinical manifestations in temporal relationship to ingestion of coriander and handling of coriander and/or fenugreek, the positive specific IgE results, skin tests and basophil activation assays support the diagnosis of allergy to both spices. History suggests sensitization by occupational exposure.

Allergenic potency of spices: hot, medium hot, or very hot

Spices are the most attractive ingredients to confer an authentic taste to food. As they are derived from plants, they harbour allergenic potency and can induce symptoms ranging from mild local to severe systemic reactions. Due to the content of pharmacologically active substances of spices, the diagnosis of allergy and the differentiation from intolerance reactions may be difficult. Association with inhalative allergies via IgE cross-reactivity, but also direct gastrointestinal sensitization plays a role. This article is a botanical and allergological overview of the most important spices and molecules responsible for eliciting IgE-mediated reactions or cross-reactions. As no curative treatments are known at present, strict avoidance is recommended and, therefore, accurate labelling of pre-packed food is necessary.