Novel and uncommon food allergies

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There are a number of foods that are eaten in geographically or culturally quite specific populations and adverse food reactions are limited to these groups. However, with diversification of cultures and diets across the globe, particularly in developed countries, adverse reactions to these foods may be seen in many other countries. A good example is sesame seed, to which allergy in Western countries was rarely reported (Rance et al. 1999). However, there are reports of an increasing number of cases of sesame seed allergy in France coincident with the increase in Middle Eastern food and fast food bread (Kolopp-Sarda et al. 1997). Sesame seed often causes severe clinical allergy hence its importance. In France sesame seed was responsible for 0.6% of IgE-mediated food allergies seen in recent years in an allergy clinic population (Rance et al. 1999).

Table 10.12 makes the point that uncommon food allergens are important causes of food allergy in specific countries. In an Israel allergy clinic population, sunflower seed was responsible for 22.3% of 112 positive food challenges in subjects between 10 and 48 years of age (Kivity et al. 1994). In Singapore, out of 124 consecutive admissions with anaphylaxis, the commonest cause was bird's nest soup (Goh et al. 1999), a food not implicated in allergy elsewhere in the world. In Japan rice appears to be a relatively common cause of allergy causing atopic eczema, although more severe acute reactions to rice are rare (Ikezawa et al. 1992). Rice is also a common cause of food allergy in Thailand (Hill et al. 1997). Adverse reaction to buckwheat is a common problem in Japan. In a population of 92,680 schoolchildren in Japan, the incidence of adverse reaction to buckwheat on questionnaire was 0.22% (Takahashi et al. 1998). The risk of anaphylaxis to buckwheat was higher than for egg and milk. In Hong Kong, royal jelly consumption is common with 31.3% of 461 hospital employees surveyed in one study consuming it (Leung et al. 1997); 7.4% of the subjects had a positive skinprick test to pure royal jelly, 0.6% had a history of clinical allergy, and nearly all employees with a positive skinprick test also had other atopic features. Pineapple allergy is responsible for a reported 23.5% of food allergy in Indonesia (Hill et al. 1997).

Table 10.12 Some uncommon foods causing allergy in specific countries

France

Japan

Hong

Singa-Kong

Spain pore

Israel

Indonesia

Poland

Lentil

Rice

Royal

Bird's

Lentil

Sun-

Pineapple

Beef

Mustard

Buck

jelly

nest

flower

Chicken

Snail

wheat

soup

seed

In Spain, with its Mediterranean diet, lentils are the legumes most commonly implicated in allergy (Pascual et al. 1999), and a common cause of anaphylaxis. Chick peas, peas, and green beans are also not uncommonly seen as causes of food allergy in Spain, with lentils, chick peas and beans forming 4.9% of the protein diet in Spain. In France, lentil is responsible for 0.8% of clinical food allergy seen in an allergy clinic, having not been seen in previous years (Rance et al. 1999). Lentils do not appear in the list of the 481 positive food challenges in a large USA allergy clinic based study (Bock et al. 1988). Mustard is an important cause of allergy in France, accounting for 6% of all food allergies seen in an allergy clinic (Rance et al. 1999), but does not appear to be a problem in other countries.

Beef allergy is a problem in Poland where it ranks among the six foods most likely to cause allergy (Czaja-Bulsa and Bachorska 1998), and is also a problem in China (Hill et al. 1997). Chicken is a common reported cause of allergy in Indonesia (Hill et al. 1997). In other countries, meats are often reported by subjects as causes of adverse reactions, but rarely confirmed by food challenge. Thus, in UK and Dutch questionnaire studies, 1.6-2.7% of respondents from random populations reported adverse reactions to meat and meat products (Young et al. 1994, Niestijl Jansen et al. 1994). However, this high figure has not been substantiated by studies involving food challenges in which adverse reactions to meats were found to be rare (Bock 1987, Crespo et al. 1995). Snail allergy is reported only from France, Spain and Portugal where it is eaten as a delicacy (de la Cuesta et al. 1989). Many of the allergic reactions are severe, involving respiratory compromise.

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