Allspice may be a tasty ingredient in Jamaican food, aromatic desserts and fruity cocktails, but researchers at Albert Einstein College of Medicine have reported what they believe to be the first case of an allspice allergy.
Prudhvi Regula, MD, an allergy and immunology fellow at Albert Einstein College of Medicine and Montefiore Medical Center, and colleagues described the case in a report published in Annals of Allergy, Asthma & Immunology.
“I personally do not find allergic reactions to spices surprising. Many spices are closely related to pollen and can cause allergic reactions because of cross-reactivity,” Regula told Healio.
For example, patients with allergies to mugwort pollen may develop mugwort-spice syndrome and react to parsley, caraway, fennel and aniseed, Regula said. These reactions usually are mild, he continued, but some patients can develop severe anaphylaxis.
“Allspice allergy is surprising, as this has not been described in the literature before,” Regula said, adding that it may be underrecognized compared with many other spice allergies.
Diagnosis may be missed because of a lack of awareness about spice allergy and a lack of commercial testing for a lot of spices, he continued. Also, spices can be hidden food allergens as manufacturers may not list individual ingredients in spice mixes or other prepared foods, he said.
The patient in this case, a woman aged 41 years with chronic seasonal allergic rhinitis, reported four episodes of severe allergic reactions including lip swelling, generalized hives, vomiting and difficulty breathing in the previous year.
Each incident resolved after self-administration of diphenhydramine. Although she reported chronic seasonal allergic rhinitis, the patient had no prior history of known food allergies.
The first incident followed dancing and peach schnapps. The second followed dancing and sangria with peaches. The third followed a pumpkin spice latte while at rest. The fourth came after eating Thai food and drinking mango juice.
Doctors performed skin testing for environmental allergens with positive results for ragweed, dust mite, weed mix, mugwort and histamine as a positive control, with negative results for normal saline as a negative control.
An oral food challenge for fresh peach was negative. But skin prick testing for ginger, nutmeg and allspice, which are ingredients of pumpkin spice latte, produced a positive reaction to allspice. Two healthy volunteers did not have any reaction to similar SPT.
After an oral food challenge to a minimal amount of allspice placed on the oral mucosa of the patient’s inside lip, she developed lip angioedema, generalized urticaria, sneezing, ocular pruritus and lacrimation within 5 minutes. Providers treated her with oral diphenhydramine, and symptoms resolved.
Although the researchers could not get any information about the ingredients involved in the fourth incident, they said they suspect that the Thai food also included allspice. The mixed drinks she consumed before the first two incidents commonly use allspice as well.
“Given our patient’s positive environmental skin test to ragweed, dust mites, weed mix and mugwort, it is possible that a culprit protein in allspice is cross-reactive to one of the proteins in weed pollen,” Regula said.
The doctors prescribed an epinephrine autoinjector and instructed the patient in avoiding allspice. Also known as Jamaican pepper, allspice is common in ketchup, Japanese curry powder, Jamaican jerk seasoning, stews and spiced desserts, among other foods.
The dried unripe berries of the tropical evergreen Pimenta dioica are the source of allspice, and its allergens have not been characterized. The researchers noted that further studies are necessary to characterize these allergens.
“Ideally, it will be very interesting to find the actual allergenic protein in allspice that is responsible for the allergic reaction and at the same time see if it cross-reacts with similar protein in weed pollen,” Regula said. “This would require complex immunochemical methods such as Western blot and Western blot inhibition, which are done in research laboratories.”
Considering the potential for severe allergic reactions, the researchers said this case highlights the importance of checking for hidden allergens in patients who present with allergic reactions without any known cause.
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Prudhvi Regula, MD, can be reached at [email protected].