Interlink of Spice, Herbs and Pollen Allergy

Introduction

Due to their aromatizing and flavoring property, herbs and spices are essential in most of our staple diet. Also, as they have potential anti-inflammatory therapeutic effects, they can be found in traditional medicine as well. Today, herbs and spices can be found ubiquitous ranging from culinary, tea, traditional medicine, household items, toothpaste, to cosmetics and etc. Many of the herbs and spices are derived from plants- such as the roots, seeds, bark, flower or even the leaves of plants.

Allergy due to spice and herbs are less heard off, or rather, under-reported, though there are increasing evidence to suggest that such cases are being missed or underdiagnosed due to lack of awareness, and a lack of proper allergy testing to identify these sensitivities. Furthermore, irritating and 'burning' nature of herbs and spices natural property may mask a person's symptoms as intolerable to spices rather than allergy.

Herbs and spices such as garlic, rosemary, basil, thyme, horseradish, turmeric, cinnamon, celery, cumin, chili, pepper, mustard, coriander, mint, sage, fennel, oregano can be associated with allergy. In this article, we would like to explore and understand the association of these commonly found plant-based substance and allergy.

How can a person develop allergy towards herbs and spices?

Atopy is the tendency of one to develop allergy. One can be genetically predisposed towards atopy. As a child who has risk of atopy, one is at risk of developing atopic dermatitis (eczema), allergic rhinitis (allergic sinus issues), food allergy and allergic asthma (wheezing and shortness of breath).

In those with atopic dermatitis, one has impaired skin barrier resulting in susceptibility to exposure of environmental allergens such as herbal and spices proteins. Over time, the immune system recognizes the allergens and mount an inflammatory exaggerated response in the form of allergy- resulting in exacerbation of the eczema symptoms, or even further development of other atopic symptoms. 

One can also be exposed to herbs and spices through diet or inhalation. In both ways, the immune system of the body is exposed to the allergen through the gut or respiratory system respectively, thereafter trigger inflammation in the gut and airway causing food allergy and allergic rhinitis/asthma respectively.

Interestingly, occupational allergies can be seen in those workers handling herbs and spices. For example, immune predisposed spice mill workers may develop allergic asthma overtime from prolonged breathing of environmental spices. Food handler of herbs and spices may develop hand dermatitis following repeated exposure to these allergens.

Cross-reactivity between herbs, spices and pollen

Similar allergenic proteins are seen in herbs, spices and pollen resulting in the body's immune system easily confused between the allergens though they are from different sources. This explains those who are sensitized towards airborne allergens such as pollen protein, may also have simultaneous reaction to food herbs and spices. This is a syndrome known as pollen-food-allergy.

A few common example here:

• Celery-birch-mugword-spices syndrome involves one a person who is being sensitized towards mugword from the air environment, develops food allergy against celery, carrot, parsley, coriander, parsley due to cross-reactivity of the proteins of different sources.
• Mustard-mugwort syndrome is another self-explanatory example from the name itself.
• Those who are allergic to mustard, chili peppers, fenugreek may also have allergic reaction towards nuts and legumes in some cases due to cross-reactivity of the proteins.
• Those with pollen sensitivity may have concurrent allergy to spices such as celery, coriander, mustard and parsley

What are the common symptoms if I have allergy to herbs and spices?

Symptoms of allergic reaction from herbs and spices can varied from mild symptoms over the exposed area to severe affecting multi-organ.

Uncommonly, yet important, there are medical documentation of anaphylaxis in children following exposure to spices such as mustard, coriander, fennel, fenugreek, black pepper, mint, sage and oregano. In adults, celery has been associated with occurrence of anaphylaxis.

It is imperative to seek medical assistance immediately when one is experiencing anaphylaxis as delay of allergy treatment can result in death and it is reversible with medication.

What can I do if I am concerned of herbs and spices allergy?

You are advised to discuss your allergy concerns with your healthcare providers. A clear clinical history with correlation of allergen, timing of exposure and reproducibility of the allergy symptoms are essential in diagnosing specific allergies. Nonetheless, in the case of herbs and spices, this can be difficult as there can be confounding factors such as food additives, other food ingredients (nuts, vegetable, meat) that can also cause allergies. 

Diagnostic tests in the form of allergy tests can be beneficial in nailing down the diagnosis. 

• Skin prick test is a quick and easy way to screen for allergy though it may not be often available commercially against allergens such as herbs and spices. 
• RAST blood tests are available for common herbs and spices to evaluate for the presence of underlying IgE allergic antibodies. 
• Oral challenge test can be useful in some cases though it can be dangerous in patients with anaphylaxis history. 
• Simultaneous laboratory evaluation of hidden food allergies, additives, pollen allergies are important in the long term management of food allergy. 

Jotting food diary, associative triggers such as exercise, medications, infections can be useful to understand more on potential underlying allergy.

If you are uncertain which tests or approach to tackle your allergy concern, it is worth consulting your healthcare provider.

What is the treatment of herbs and spices allergy?

• Once the culprit spice or herb is pinpointed, avoidance is key in preventing occurrence of allergies.
• Anti-histamine and steroid medication remains the backbone treatment in alleviating allergic symptoms.
• In those with history of anaphylaxis following exposure to herbs or spices, adrenaline injection (epipen) should be advised to carry at all times. One should be counselled to recognize anaphylaxis symptoms and administer epipen without any delay.
• Food ingredient labels should be read through, restaurant should be informed prior food preparation if one suffers from herbs and spices allergy.
• It is also important to read through labels of non-food items that may contain herbs and spices. These items include toothpaste, essential oil, cosmetics, aromatherapy, fragrances, household produces and etc.
• In children, the school and caregivers should be counselled and informed of potential allergy, and troubleshoot with medical assistance if need without delay.
• While medical evidence may not be conclusive, in oral-pollen syndrome, there is potential benefit in immunotherapy treatment against inhalant allergies in the long term management of herbs and spices allergies due to the cross linkage of the allergens. 

Take home messages...

• Although under-reported, herbs and spices can be associated with allergy.
• These plant-based substances tend to cross-link with pollen due to their similarity in allergenic proteins.
• Allergy symptoms from herbs and spices can be mild, localized or extensive affecting various organs and anaphylaxis. 
• Diagnosis of herbs and spices allergy can be challenging due to poor history, concurrent exposure to other potential allergenic proteins in the environment and lack of testing resources and test standardization.
• Allergy tests and oral challenge tests can be beneficial in teasing out underlying herbs and spices allergy.
• Management of allergy against herbs and spices involve food avoidance, symptomatic medications and possible use of immunotherapy in those with oral-pollen syndrome.

Contact DB Clinic

If you’re experiencing symptoms that may be linked to spice, herb, or pollen allergies, a proper medical assessment can help clarify the cause. At DB Clinic, our doctors provide personalised allergy evaluations and guidance tailored to your condition. You may book a consultation to discuss your symptoms and suitable management options.

References:

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