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.

1.
Clarke RC: Hashish! Los Angeles, Red Eye Press, 1998.
2.
European Monitoring Centre for Drugs and Drug Addiction: Cannabis. Annual report on the state of the drugs problem in Europe, 2011, pp 40-48. http://www.emcdda.europa.eu/attachements.cfm/att_143743_EN_EMCDDA_AR2011_EN.pdf (accessed 6 September 2012).
3.
Liskow B, Liss JL, Parker CW: Allergy to marihuana. Ann Intern Med 1971;75:571-573.
4.
Añibarro B, Fontela JL: Allergy to marihuana. Allergy 1996;51:200-201.
5.
Tessmer A, Berlin N, Sussman G, Leader N, Chung EC, Beezhold D: Hypersensitivity reactions to marijuana. Ann Allergy Asthma Immunol 2012;108:282-284.
6.
Majmudar V, Azam NA, Finch T: Contact urticaria to Cannabis sativa. Contact Dermatitis 2006;54:127.
7.
Pérez JA: Allergic reaction associated with intravenous marijuana use. J Emerg Med 2000;18:260-261.
8.
Singh AB, Kumar P: Aeroallergens in clinical practice of allergy in India. An overview. Ann Agric Environ Med 2003;10:131-136.
9.
Freeman GL: Allergic skin test reactivity to marijuana in the Southwest. West J Med 1983;138:829-831.
10.
Stokes JR, Hartel R, Ford LB, Casale TB: Cannabis (hemp) positive skin tests and respiratory symptoms. Ann Allergy Asthma Immunol 2000;85:238-240.
11.
de Larramendi CH, Carnés J, García-Abujeta JL, Garcia-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.
12.
Armentia A, Castrodeza J, Ruiz-Muñoz P, Martínez-Quesada J, Postigo I, Herrero M, González-Sagrado M, de Luis D, Martín-Armentia B, Guisantes JA: Allergic hypersensitivity to cannabis in patients with allergy and illicit drug users. Allergol Immunopathol 2011;39:271-279.
13.
Gamboa P, Sánchez-Monge R, Sanz ML, Palacín A, Salcedo G, Díaz-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.
14.
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.
15.
Breiteneder H: Thaumatin-like proteins - a new family of pollen and fruit allergens. Allergy 2004;59:479-481.
16.
Lindemayr H, Jäger S: Occupational immediate type allergy to hemp pollen and hashish.Derm Beruf Umwelt 1980;28:17-19.
17.
Herzinger T, Schöpf P, Przybilla B, Ruëff F: IgE-mediated hypersensitivity reactions to cannabis in laboratory personnel. Int Arch Allergy Immunol 2011;156:423-426.
18.
Pletcher MJ, Vittinghoff E, Kalhan R, Richman J, Safford M, Sidney S, Lin F, Kertesz S: Association between marijuana exposure and pulmonary function over 20 years. JAMA 2012;307:173-181.
19.
Tetrault JM, Crothers K, Moore BA, Mehra R, Concato J, Fiellin DA: Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med 2007;167:221-228.
20.
Sánchez-Monge R, Lombardero M, García-Selles FJ, Barber D, Salcedo G: Lipid-transfer proteins are relevant allergens in fruit allergy. J Allergy Clin Immunol 1999;103:514-519.
21.
Fernández-Rivas M, González-Mancebo E, Rodríguez-Pérez R, Benito C, Sánchez-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.
22.
Salcedo G, Sánchez-Monge R, Díaz-Perales A, García-Casado G, Barber D: Plant non-specific lipid transfer proteins as food and pollen allergens. Clin Exp Allergy 2004;34:1336-1341.
23.
Fils-Lycaon BR, Wiersma PA, Eastwell KC, Sautiere P: A cherry protein and its gene, abundantly expressed in ripening fruit, have been identified as thaumatin-like. Plant Physiol 1996;111:269-273.
24.
Sharma P, Singh AK, Singh BP, Gaur SN, Arora N: Allergenicity assessment of osmotin, a pathogenesis-related protein, used for transgenic crops. J Agric Food Chem 2011;59:9990-9995.
25.
Bublin M, Mari A, Ebner C, Knulst A, Scheiner O, Hoffmann-Sommergruber K, Breiteneder H, Radauer C: IgE sensitization profiles toward green and gold kiwifruits differ among patients allergic to kiwifruit from 3 European countries. J Allergy Clin Immunol 2004;114:1169-1175.
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