Cannabis allergy Z88.9

Consumption of the intoxicant cannabis may cause nonspecific respiratory symptoms such as bronchiolitis, alveolar hemorrhage, and chronic bronchitis. Sensitization of the immediate type, less frequently of the delayed type, to Cannabis sativa is increasingly reported.

Prevalences about cannabis allergy are not available. In recent years, they have been increasing.

In many regions of the U.S., it has been demonstrated that airborne flower pollen can contain high levels of cannabis pollen. In 1983, pollen allergy sufferers from Arizona had a 70% positive reaction to cannabis pollen. In another study of asthma patients with sensitizations to versch. In another study of asthma patients with sensitization to various flower pollens, tobacco, tomatoes or latex, 53% reacted to cannabis.

Main allergens: lipid transfer protein andthaumatin-like protein.

Lipid transfer proteins have been characterized as minor allergens in various fruits. Fruits such as apple (Mal d 2), cherries (Pru av 2), kiwi (Act d 2), golden kiwi, oranges and grapefruits as well as in the pollen of cedars (Jun a 3), cypresses (Cup a 3). Lipid transfer proteins prove to be heat stable. Their allergenicity persists even after gastrointestinal digestion. The lipid transfer protein Can s 3 is held responsible for the Cannabis fruit-vegetable syndrome (Drouet M et al. 2017).

Thaumatin proteins (E 957) occur naturally in sweetener mixtures (analyzed 6 proteins are found, for example, in the berries of the West African katamfe plant (Thaumatococcus daniellii). Thaumatin proteins belong to a family of stress proteins produced by many plants in response to insect attack or infection. Thaumatin proteins possess fungicidal activity and have relevant allergological potency. They constitute the largest proportion of proteins in all wine varieties.

Also the psychoactive substance of cannabis, delta-9-tetrahydrocannabinol is attributed an allergenic potential.

Sensitization to cannabis may occur during the cultivation of the plants via inhalation of pollen; furthermore by direct skin contact with the plant as well as by inhalation during preparation and application.

Clinical symptoms are: bronchial asthma, allergic rhinitis, allergic conjunctivitis.

Furthermore, contact urticaria, contact allergic eczema, food and effort associated anaphylaxis (see below anaphylaxis, wheat dependent, effort induced) and erythema exsudativum multiforme have been described.

25-year-old woman; after smoking a cannabis cigarette (regular consumption of hash had preceded it) she developed clear symptoms of bronchial asthma for the first time, as well as acute urticaria, which had to be treated in an emergency.

An exertion-associated anaphylaxis was known.

In the prick test (standardised products are currently not available) positive reactions against cannabis extracts were detected.

1. Armentia A et al (2011) Allergic hypersensitivity to cannabis in patients with allergy and illicit drug users. Allergol Immunopathol 39: 271-279
2. Asero R (2014) In patients with LTP syndrome food-specific IgE show a predictable hierarchical order. Eur Ann Allergy Clin Immunol 46:142-146
3. Drouet M et al (2017) Cannabis et allergie croisée alimentaire Cannabis and crossed allergy with food. Revue de pneumologie clinique 73:290-293.
4. Gomez F et al (2014) High prevalence of lipid transfer protein sensitization in apple allergic patients with systemic symptoms. PLoS One doi: 10.1371/journal.pone.
5. Larramendi CH et al (2013) Prevalence of sensitization to Cannabis sativa. Lipid-transfer and thaumatin-like proteins are relevant allergens. Int Arch Allergy Immunol. 162:115-122
6. Marangon M et al (2014) Structure of Haze Forming Proteins in White Wines: Vitis vinifera Thaumatin-Like Proteins. PLoS One 9: e113757
7. Ozyurt S et al (2012) Cannabis-induced erythema multiforme-like recurrent drug eruption. Int J Dermatol 53: 1365-1367
8. Rihs HP et al (2014) IgE-binding properties of a recombinant lipid transfer protein from Cannabis sativa. Ann Allergy Asthma Immunol 113:233-234
9. Rojas Pérez-Ezquerra P et al (2014) Contact urticaria to Cannabis sativa due to a lipid transfer protein (LTP). Allergol Immunopathol (Madr) doi: 10.1016/j.aller.2013.10.002.
10. Swerts S et al (2014) Allergy to illicit drugs and narcotics. Clin Exp Allergy 44: 307-318
11. Tessmer A et al (2012) Hypersensitivity reactions to marijuana. Ann Allergy Asthma Immunol 108:282 -284
12. Wang X et al (2008) Cross-shift airway responses and long-term decline in FEV1 in cotton textile workers. At J Respir Crit Care Med 177:316-320