Background: Allergy to fruit and vegetables exhibit geographic variation regarding the severity of symptoms and depending on the sensitization profile of the patient. These sensitization profiles and routes remain incompletely understood. Cannabis is a very popular drug and derived from Cannabis sativa, a plant containing lipid transfer proteins (LTP) also known as important allergens in plant and fruit allergies. In this study we sought to elucidate a potential connection between C. sativa allergy and plant food allergies. Methods: A case-control study involving 21 patients consulting for plant food allergies. Twelve patients were cannabis allergic and 9 had a pollen or latex allergy without cannabis allergy. Testing for cannabis IgE implied measurement of specific IgE, skin testing and basophil activation tests. Allergen component analysis was performed with a microarray technique. Results: Plant food allergy in patients with documented cannabis allergy had more severe reactions than patients without cannabis allergy and frequently implied fruits and vegetables that are not observed in a (birch) pollen-related food syndrome. With the exception of 1 patient with cannabis allergy, all were sensitized to nonspecific (ns)-LTP. Conclusion: Our data suggest that illicit cannabis abuse can result in cannabis allergy with sensitization to ns-LTP. This sensitization might result in various plant-food allergies. Additional collaborative studies in different geographical areas are needed to further elucidate on this hypothesis.

1.
Allen KJ, Koplin JJ: The epidemiology of IgE-mediated food allergy and anaphylaxis. Immunol Allergy Clin North Am 2012;32:35-50.
2.
Ballmer-Weber BK, Hoffmann-Sommergruber K: Molecular diagnosis of fruit and vegetable allergy. Curr Opin Allergy Clin Immunol 2011;11:229-235.
3.
Fernandez-Rivas M, Bolhaar S, Gonzalez-Mancebo E, Asero R, van LA, Bohle B, Ma Y, Ebner C, Rigby N, Sancho AI, Miles S, Zuidmeer L, Knulst A, Breiteneder H, Mills C, Hoffmann-Sommergruber K, van RR: Apple allergy across Europe: how allergen sensitization profiles determine the clinical expression of allergies to plant foods. J Allergy Clin Immunol 2006;118:481-488.
4.
Hansen KS, Ballmer-Weber BK, Sastre J, Lidholm J, Andersson K, Oberhofer H, Lluch-Bernal M, Ostling J, Mattsson L, Schocker F, Vieths S, Poulsen LK: Component-resolved in vitro diagnosis of hazelnut allergy in Europe. J Allergy Clin Immunol 2009;123:1134-1141.
5.
Ebo DG, Bridts CH, Verweij MM, De Knop KJ, Hagendorens MM, De Clerck LS, Stevens WJ: Sensitization profiles in birch pollen-allergic patients with and without oral allergy syndrome to apple: lessons from multiplexed component-resolved allergy diagnosis. Clin Exp Allergy 2010;40:339-347.
6.
De Knop KJ, Verweij MM, Grimmelikhuijsen M, Philipse E, Hagendorens MM, Bridts CH, De Clerck LS, Stevens WJ, Ebo DG: Age-related sensitization profiles for hazelnut (Corylus avellana) in a birch-endemic region. Pediatr Allergy Immunol 2011;22:e139-e149.
7.
Andersen MB, Hall S, Dragsted LO: Identification of European allergy patterns to the allergen families PR-10, LTP, and profilin from Rosaceae fruits. Clin Rev Allergy Immunol 2011;41:4-19.
8.
Vereda A, van Hage M, Ahlstedt S, Ibanez MD, Cuesta-Herranz J, van Odijk J, Wickman M, Sampson HA: Peanut allergy: clinical and immunologic differences among patients from 3 different geographic regions. J Allergy Clin Immunol 2011;127:603-607.
9.
Nicolaou N, Custovic A: Molecular diagnosis of peanut and legume allergy. Curr Opin Allergy Clin Immunol 2011;11:222-228.
10.
Sanchez-Monge R, Lombardero M, Garcia-Selles FJ, Barber D, Salcedo G: Lipid-transfer proteins are relevant allergens in fruit allergy. J Allergy Clin Immunol 1999;103:514-519.
11.
Richard C, Leduc V, Battais F: Plant lipid transfer proteins (LTPS): biochemical aspect in panallergen - structural and functional features, and allergenicity. Eur Ann Allergy Clin Immunol 2007;39:76-84.
12.
Egger M, Hauser M, Mari A, Ferreira F, Gadermaier G: The role of lipid transfer proteins in allergic diseases. Curr Allergy Asthma Rep 2010;10:326-335.
13.
Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Ispano M, Monza M, Baroglio C, Scibola E, Ansaloni R, Incorvaia C, Conti A: The major allergen of peach (Prunus persica) is a lipid transfer protein. J Allergy Clin Immunol 1999;103:520-526.
14.
Fernandez-Rivas M, Gonzalez-Mancebo E, Rodriguez-Perez R, Benito C, Sanchez-Monge R, Salcedo G, Alonso MD, Rosado A, Tejedor MA, Vila C, Casas ML: Clinically relevant peach allergy is related to peach lipid transfer protein, Pru p 3, in the Spanish population. J Allergy Clin Immunol 2003;112:789-795.
15.
Asero R, Mistrello G, Roncarolo D, Amato S: Relationship between peach lipid transfer protein specific IgE levels and hypersensitivity to non-Rosaceae vegetable foods in patients allergic to lipid transfer protein. Ann Allergy Asthma Immunol 2004;92:268-272.
16.
Romano A, Fernandez-Rivas M, Caringi M, Amato S, Mistrello G, Asero R: Allergy to peanut lipid transfer protein (LTP): frequency and cross-reactivity between peanut and peach LTP. Eur Ann Allergy Clin Immunol 2009;41:106-111.
17.
Hartz C, Lauer I, del Mar San Miguel Moncin M, Cistero-Bahima A, Foetisch K, Lidholm J, Vieths S, Scheurer S: Comparison of IgE-binding capacity, cross-reactivity and biological potency of allergenic non-specific lipid transfer proteins from peach, cherry and hazelnut. Int Arch Allergy Immunol 2010;153:335-346.
18.
Schulten V, Nagl B, Scala E, Bernardi ML, Mari A, Ciardiello MA, Lauer I, Scheurer S, Briza P, Jurets A, Ferreira F, Jahn-Schmid B, Fischer GF, Bohle B: Pru p 3, the nonspecific lipid transfer protein from peach, dominates the immune response to its homolog in hazelnut. Allergy 2011;66:1005-1013.
19.
Salcedo G, Sanchez-Monge R, Diaz-Perales A, Garcia-Casado G, Barber D: Plant non-specific lipid transfer proteins as food and pollen allergens. Clin Exp Allergy 2004;34:1336-1341.
20.
Zuidmeer L, Van Ree R: Lipid transfer protein allergy: primary food allergy or pollen/food syndrome in some cases. Curr Opin Allergy Clin Immunol 2007;7:269-273.
21.
Borghesan F, Mistrello G, Roncarolo D, Amato S, Plebani M, Asero R: Respiratory allergy to lipid transfer protein. Int Arch Allergy Immunol 2008;147:161-165.
22.
UN Office on Drugs and Crime: World drug report 2011. http://www.humansecuritygateway.com/showRecordphp?RecordId=35492.
23.
Degenhardt L, Hall W: Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 2012;379:55-70.
24.
Gamboa P, Sanchez-Monge R, Sanz ML, Palacin A, Salcedo G, Diaz-Perales A: Sensitization to Cannabis sativa caused by a novel allergenic lipid transfer protein, Can s 3. J Allergy Clin Immunol 2007;120:1459-1460.
25.
de Larramendi CH, Carnes J, Garcia-Abujeta JL, Garcia-Endrino A, Munoz-Palomino E, Huertas AJ, Fernandez-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.
26.
Metz-Favre C, Pauli G, Bessot JC, De BF: Molecular allergology in practice: an unusual case of LTP allergy. Eur Ann Allergy Clin Immunol 2011;43:193-195.
27.
Ebo DG, Lechkar B, Schuerwegh AJ, Bridts CH, De Clerck LS, Stevens WJ: Validation of a two-color flow cytometric assay detecting in vitro basophil activation for the diagnosis of IgE-mediated natural rubber latex allergy. Allergy 2002;57:706-712.
28.
Tomassen MMM, Barrett DM, van der Valk HPCM, Woltering EJ: Isolation and characterization of a tomato non-specific lipid transfer protein involved in polygalacturonase-mediated pectin degradation. J Experimental Botany 2007;28:1151-1160.
29.
Ebo DG, Bridts CH, Mertens CH, Hagendorens MM, Stevens WJ, De Clerck LS: Analyzing histamine release by flow cytometry (HistaFlow): a novel instrument to study the degranulation patterns of basophils. J Immunol Methods 2012;375:30-38.
30.
Spiewak R, Gora A, Dutkiewicz J: Work-related skin symptoms and type I allergy among eastern-Polish farmers growing hops and other crops. Ann Agric Environ Med 2001;8:51-56.
31.
Williams C, Thompstone J, Wilkinson M: Work-related contact urticaria to Cannabis sativa. Contact Dermatitis 2008;58:62-63.
32.
Herzinger T, Schopf P, Przybilla B, Rueff F: IgE-mediated hypersensitivity reactions to cannabis in laboratory personnel. Int Arch Allergy Immunol 2011;156:423-426.
33.
Liskow B, Liss JL, Parker CW: Allergy to marihuana. Ann Intern Med 1971;75:571-573.
34.
Anibarro B, Fontela JL: Allergy to marihuana. Allergy 1996;51:200-201.
35.
Perez JA Jr.: Allergic reaction associated with intravenous marijuana use. J Emerg Med 2000;18:260-261.
36.
Stadtmauer G, Beyer K, Bardina L, Sicherer SH: Anaphylaxis to ingestion of hempseed (Cannabis sativa). J Allergy Clin Immunol 2003;112:216-217.
37.
Armentia A, Castrodeza J, Ruiz-Munoz P, Martinez-Quesada J, Postigo I, Herrero M, Gonzalez-Sagrado M, de Luis D, Martin-Armentia B, Guisantes JA: Allergic hypersensitivity to cannabis in patients with allergy and illicit drug users. Allergol Immunopathol (Madr) 2011;39:271-279.
38.
Tessmer A, Berlin N, Sussman G, Leader N, Chung EC, Beezhold D: Hypersensitivity reactions to marijuana. Ann Allergy Asthma Immunol 2012;108:282-284.
39.
Geroldinger-Simic M, Zelniker T, Aberer W, Ebner C, Egger C, Greiderer A, Prem N, Lidholm J, Ballmer-Weber BK, Vieths S, Bohle B: Birch pollen-related food allergy: clinical aspects and the role of allergen-specific IgE and IgG4 antibodies. J Allergy Clin Immunol 2011;127:616-622.
40.
Gamboa PM, Caceres O, Antepara I, Sanchez-Monge R, Ahrazem O, Salcedo G, Barber D, Lombardero M, Sanz ML: Two different profiles of peach allergy in the north of Spain. Allergy 2007;62:408-414.
41.
Asero R, Antonicelli L, Arena A, Bommarito L, Caruso B, Colombo G, Crivellaro M, De Carli M, Della TE, Della TF, Heffler E, Lodi RF, Longo R, Manzotti G, Marcotulli M, Melchiorre A, Minale P, Morandi P, Moreni B, Moschella A, Murzilli F, Nebiolo F, Poppa M, Randazzo S, Rossi G, Senna GE: Causes of food-induced anaphylaxis in Italian adults: a multi-centre study. Int Arch Allergy Immunol 2009;150:271-277.
42.
Asero R, Mistrello G, Roncarolo D, Amato S: Detection of some safe plant-derived foods for LTP-allergic patients. Int Arch Allergy Immunol 2007;144:57-63.
43.
Vallier P, Balland S, Harf R, Valenta R, Deviller P: Identification of profilin as an IgE-binding component in latex from Hevea brasiliensis: clinical implications. Clin Exp Allergy 1995;25:332-339.
44.
Nieto A, Mazon A, Boquete M, Carballada F, Asturias JA, Martinez J, Martinez A: Assessment of profilin as an allergen for latex-sensitized patients. Allergy 2002;57:776-784.
45.
Scheurer S, Lauer I, Foetisch K, San Miguel MM, Retzek M, Hartz C, Enrique E, Lidholm J, Cistero-Bahima A, Vieths S: Strong allergenicity of Pru av 3, the lipid transfer protein from cherry, is related to high stability against thermal processing and digestion. J Allergy Clin Immunol 2004;114:900-907.
46.
Sancho AI, Rigby NM, Zuidmeer L, Asero R, Mistrello G, Amato S, Gonzalez-Mancebo E, Fernandez-Rivas M, van RR, Mills EN: The effect of thermal processing on the IgE reactivity of the non-specific lipid transfer protein from apple, Mal d 3. Allergy 2005;60:1262-1268.
47.
Matejkova M, Zidkova J, Zidek L, Wimmerova M, Chmelik J, Sklenar V: Investigation of thermal denaturation of barley nonspecific lipid transfer protein 1 (ns-LTP1b) by nuclear magnetic resonance and differential scanning calorimetry. J Agric Food Chem 2009;57:8444-8452.
48.
Wijesinha-Bettoni R, Alexeev Y, Johnson P, Marsh J, Sancho AI, Abdullah SU, Mackie AR, Shewry PR, Smith LJ, Mills EN: The structural characteristics of nonspecific lipid transfer proteins explain their resistance to gastroduodenal proteolysis. Biochemistry 2010;49:2130-2139.
49.
Cavatorta V, Sforza S, Aquino G, Galaverna G, Dossena A, Pastorello EA, Marchelli R: In vitro gastrointestinal digestion of the major peach allergen Pru p 3, a lipid transfer protein: molecular characterization of the products and assessment of their IgE binding abilities. Mol Nutr Food Res 2010;54:1452-1457.
50.
Diaz-Perales A, Tabar AI, Sanchez-Monge R, Garcia BE, Gomez B, Barber D, Salcedo G: Characterization of asparagus allergens: a relevant role for asparagus LTP. J Allergy Clin Immunol 2002;110:796.
51.
Gadermaier G, Harrer A, Girbl T, Palazzo P, Himly M, Vogel L, Briza P, Mari A, Ferreira F: Isoform identification and characterization of Art v 3, the lipid-transfer protein of mugwort pollen. Mol Immunol 2009;46:1919-1924.
52.
Tordesillas L, Sirvent S, Diaz-Perales A, Villalba M, Cuesta-Herranz J, Rodriguez R, Salcedo G: Plant lipid transfer protein allergens: no cross-reactivity between those from foods and olive and Parietaria pollen. Int Arch Allergy Immunol 2011;156:291-296.
53.
Hiemori M, Eguchi Y, Kimoto M, Yamasita H, Takahashi K, Takahashi K, Tsuji H: Characterization of new 18-kDa IgE-binding proteins in beer. Biosci Biotechnol Biochem 2008;72:1095-1098.
54.
Quercia O, Zoccatelli G, Stefanini GF, Mistrello G, Amato S, Bolla M, Emiliani F, Asero R: Allergy to beer in LTP-sensitized patients: beers are not all the same. Allergy 2012;67:1186-1189.
55.
Pastorello EA, Farioli L, Pravettoni V, Ortolani C, Fortunato D, Giuffrida MG, Perono GL, Calamari AM, Brenna O, Conti A: Identification of grape and wine allergens as an endochitinase 4, a lipid-transfer protein, and a thaumatin. J Allergy Clin Immunol 2003;111:350-359.
56.
Schad SG, Trcka J, Vieths S, Scheurer S, Conti A, Brocker EB, Trautmann A: Wine anaphylaxis in a German patient: IgE-mediated allergy against a lipid transfer protein of grapes. Int Arch Allergy Immunol 2005;136:159-164.
57.
Sbornik M, Rakoski J, Mempel M, Ollert M, Ring J: IgE-mediated type-I-allergy against red wine and grapes. Allergy 2007;62:1339-1340.
58.
Wigand P, Tenzer S, Schild H, Decker H: Analysis of protein composition of red wine in comparison with rose and white wines by electrophoresis and high-pressure liquid chromatography-mass spectrometry (HPLC-MS). J Agric Food Chem 2009;57:4328-4333.
59.
Gaier S, Oberhuber C, Hemmer W, Radauer C, Rigby NM, Marsh J, Mims JW, Siafakas N, Hoffmann-Sommergruber K: Pru p 3 as a marker for symptom severity for patients with peach allergy in a birch environment. J Allergy Clin Immunol 2009;166-167.
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