Mustard: A Priority Food Allergen in Canada
Author, Year, Country | Study Design Details | Subjects | Clinical History | Symptoms & SignsFootnote 1 (before challenge) | Symptoms & SignsFootnote 1 after Challenge | Diagnostic TestsFootnote 3 | Eliciting Dose | Eliciting Allergen | Prevalence | Comments |
---|---|---|---|---|---|---|---|---|---|---|
1. Double-Blind, Placebo-Controlled Food Challenge (DBPCFC) | ||||||||||
a. Randomized | ||||||||||
Figueroa et al., 2005 Spain |
Prospective Questionnaire & CH Increasing Dose: 80, 240, 800, 2400, 6480 mg w/ 15 min interval until symptoms appeared or cumulative 24/38 (83%) CH w/ Mus 14/38 (37%) excluded because SEV of symptoms or did not agree to enter the food CH |
38 SUB Age: 5/38= 14y Average: 21.9±8.6y Sex: 20F:18M |
Hx of A in 11% of SUB (exclude from CH) Hx of atopy in 92% of SUB Hx of primary Res Sen in 83% of SUB |
A: 11% EIA: 3% OAS: 47% U/AE 42% |
Positive Rxn 14/24 (58%) Type of Rxn: OAS 10/14 (71%) AE+BA 1/14 (7%) A 1/14 (7%) in a SUB w/ out previous Hx of A |
SPT to a panel of aero-allergens and food extracts IgEto mugwort pollen, mustard, cabagge, broccoli etc. |
Mean cumulative dose (until reaction appeared or max dose reached): Eliciting dose in most severe cases: 156.8mg of Mus sauce lowest dose eliciting a reaction was 44.8mg of Mus sauce |
Mus sauce Meta-bisulfite freeFootnote 4 |
58% of SUB positive for Mus allergy |
Cross-Rxn w/ mugwort pollen: 97% SUB Other food Sen 42% SUB Sen to Brassicaceae 100% SUB Assoc. EIA 2% SUB |
b. Non-randomized | ||||||||||
Morisset et al., 2003 France |
Doses 10, 30, 100, 300900 every 20 min with a cumulative dose of 1340 mg Mus seasoning amount selected based on routine consumption 24 SUB DBPCFC 6 SUB SBPCFC |
30 SUB Ch:28/30 Age: 3-20 y Sex: 11F:19M |
Hx of Rxn to ingestion of Mus Screened for Mus allergy by PST and IgE. |
U,AE,AD BA, abdominal pain, diarrhea |
Positive Rxn 7/30 (23%) Type of Rxn: SK e.g. pruritus, erythema 5/7 (72%) GI /Res e.g.: abdominal pain, diarrhea, sneezing, wheezing 4/7 (57%) |
SPT to Mus seed, Mus flour and metabisulfite-free Mus Mustard specific IgE |
Lowest dose inducing symptoms: 1 Ch 40 mg Mus (0.8mg of protein). Subject Sen by mustard pollen and rape pollen Another Ch 440 mg Mus |
Mus seasoning (B. juncea seed) containing 34% Mus seed and 6% Mus protein Metabisulfite-free* |
23% SUB positive for Mus allergy |
SEV of certain Rxns argues for an informative labelling, Mus often masked allergen in many manufacture sauces |
2. Single-Blind, Placebo-Controlled Food Challenge (SBPCFC) | ||||||||||
a. Non-randomized | ||||||||||
Rancé et al., 2000 & 2001 France |
SUB selected for by positive Mus SPT Compared SUB to 22 controls w/out Hx of food allergy Increasing doses: 1, 5, 10, 20, 50, 100, 250 and 500 mg Mus |
36 Ch Age: 10 m-15 y Sex : 22M:14F |
15/30 ch w/ previous hx of food allergy Family Hx of atopy 81% 8/15 SUB (53.3%) exhibited Rxn to Mus under the age of 3 years |
Of the 54 initial clinical features: AD 52% U/AE 37% BA 9% laryngeal edema + OAS + C 2% |
Mustard allergy confirmed in 15/36 (42%) Most common reaction: U 14/15 (93%) |
SPT IgE |
1 to 936 mg Mus powder Mean cumulative dose: 153 mg Mus powder |
Mus powder |
42% SUB positive for Mus allergy Symptoms started =3 y of age in 53% of the subjects |
67 % SUB were also allergic to other foods- peanuts, eggs & milk Possible Sen in utero or lactation Mustard in baby food |
Author, Year, Country | Study Design Details | Subjects | Clinical History | Symptoms & SignsFootnote 1 (before challenge) | Symptoms & SignsFootnote 1 Severity of RxnFootnote 2 after Challenge | Diagnostic TestsFootnote 3 | Eliciting Dose | Eliciting Allergen | Prevalence | Comments |
---|---|---|---|---|---|---|---|---|---|---|
Niinimaki et al.,1989 Finland |
Open study assessing allergy to spices including Mus using SPT and RAST |
50 SUB Age: 1-47y Sex: 25M:25F 3 Ch: Age 1-1.5y (never ingested Mus; breast-feed for 11m) |
Hx allergy to spices & birch pollen 64% Hx of atopy 96% Res/OC Sen |
Gastric pain R AD 26% |
Positive Rxn to SPT 29/50 (58%) RAST and SPT correlation good Ch who never ingested Mus had positive SPT Rxn |
SPT RAST |
0.648 g Mus dissolved in glycerol & saline to make 5% (w/v) test solution |
Commercial powdered Mus |
58% SUB positive for Mus by either one or both SPT/RAST |
40/50 (80%) SUB positive SPT & RAST to birch pollen 15/50 (30%) SUB positive SPT & RAST to mugwort pollen |
Rancé et al., 1994 France |
Open study assessing allergy to spices including Mus using SPT and IgE 7/23 SUB had LFC and/or OFC conducted with Mus |
83 SUB (Ch) tested for allergy to spices Age: 15m to 16y Sex :50M:33F |
Hx of pollen and food allergy |
Chronic U or recurrent AE/E |
Positive SPT for Mus in 23/83 SUB (28%) 6 SUB positive for Mus LFC & 1 SUB positive in OFC Symptoms specific to Mus : |
SPT IgE |
Not reported |
Commercial extract |
39/83 SUB (46%) positive (SPT & IgE) allergy to spices 23/39 SUB (59%) positive allergy to mustard 7/23 SUB (30%) |
ollen allergy existed in 56% of Ch allergic to spices |
Niinimaki et al., 1995 Finland |
Open study assessing allergy to spices including Mus using SPT, RAST: IgEat 2m and 2.9y intervals |
49 SUB Age: 1 to 51y Sex: 23M: 26F |
Hx allergy to spices & birch pollen Hx of atopy |
Atopic dermatitis w/ Res symptoms 57% Chronic E |
Positive Rxn to Mus specific IgE |
SPT |
4 mg powdered spice and 50 µL of saline on the skin |
Native Mus (Sinapis alba & Brassica nigra) |
31/49 (63%) SUB positive SPT 22/31 (71%) SUB positive for Mus allergy 22/49 (45%) SUB positive for Mus allergy |
Concomitant Rxn to native spices seen in 19/29 SUB who were tested with all spices 38/46 (83%) positive to birch pollen |
Rancé & Dutau, 1997 France |
Open allergy study assessing over 25 allergens including Mus using SPT, IgE LFC and SBPCFC (when LFC negative) |
142 SUB (Ch) Age: 7m to 15y Sex: 95M:47F |
Hx of food allergy |
Multiple presenting symptoms in 66% Ch |
Positive for Mus allergy 23/142 (16%) Multiple symptoms per Ch.(not specific to Mus) |
SPT IgE |
1 mg to 5 g for all allergens tested Further details not provided |
extracted from local food |
23/202 SUB (11%) positive for Mus allergy |
Mus 3rd most common food allergy in study |
Rancé & Dutau, 1998 France |
Open allergy study assessing foodstuff including Mus using SPT, IgE and open LFC |
45 Ch Age: 3m to 9y Sex: 30M: 15F |
Family Hx of atopy: 78% SUB AD: 93% 44% SUB w/ allergy to =3 foods |
U 30% |
Positive allergy to mustard |
SPT IgE |
Mean dose by OFC 900mg |
Details not provided |
Positive allergy to Mus 12% SUB |
None |
Rancé and Dutau, 2002 France |
Open allergy study assessing foodstuff including Mus documented by DBPCFC in BA patients identified by pulmonary function |
163 Ch Age: 2 to 17 y Sex: 108M:54F |
Family Hx atopy 91 % Hx of = 1 food allergies BA for ave. 5.5 y |
SK 59%; |
Asthma induced by food allergens potentially severe. A 6% |
SPT IgE |
Details not provided |
Various food extracts |
Positive allergy to Mus 7% SUB |
Prevalence of asthma induced by food allergen: 10% |
Author, Year, Country | Study Design Details | Subjects | Clinical History | Symptoms & SignsFootnote 1 (before challenge) | Symptoms & SignsFootnote 1 Severity of RxnFootnote 2 after Challenge | Diagnostic TestsFootnote 3 | Eliciting Dose | Eliciting Allergen | Prevalence | Comments |
---|---|---|---|---|---|---|---|---|---|---|
André et al., 1994 France |
Retrospective Analysis 9 y period investigating foodstuff most frequently associated with A Rxn |
580 SUB 480 Ad Age: 1-83 y Sex: 290M: 290F |
Hx of adverse Rxn to food |
60/580 SUB Hx severe Rxn to food |
Not applicable to study design |
SPT IgE |
Details not provided |
Mustard |
3% of SUB positive for ser Rxn to Mus |
An increase in the frequency of sen (1%) to Mus was noted |
Rancé et al., 1998 & 1999 a, b France |
Prospective prevalence study of food allergy validated by SPT/IgE/ LFC |
Ch 544 Age: 0-15 Sex: 343M: 201F |
Hx food allergy confirmed by food challenge Family Hx atopia 71% |
AD 275/544 (51%) U/AE 165/544 (30%) BA 47/544 (9%) A 27/544 (5%) |
49/544 (9%) positive Rxn to Mus AD 21/49 (43%) |
SPT IgE |
0.1-10g for all allergens tested Dose specific to mustard: not reported |
Test substances extracted from local food |
49/544 (9%) SUB positive for Mus allergy |
Mus 4th most common allergy identified within a population with multiple food allergy |
Caballeros et al., 2002 Spain |
Cohort |
29 SUB Age: 15-58y Sex: 10M:19F |
Family Hx of atopy 50% SUB allergy to other vegetables 17% allergy to non-vegetables 52% symptoms of pollinosis |
Mus allergy confirmed by SPT and IgE |
19/29 (65%) SUB systemic Rxn 14/19 (74%) A AE 16/29 Dyspnea 11/29 U 10/29 OAS 8/29 Most common symptom U & AE. |
SPT total IgE Mus specific IgE |
Details not provided Trace amounts reported to elicit Rxn |
Mus extract of B. nigra at 1:10 w/v |
Not applicable study population 100% positive allergic Rxn to Mus |
Mustard seed allergens are resistant to digestion and high temperature No challenge Study due to risk of sev Rxn |
Author, Year, Country | Cases | Clinical History | Symptoms & SignsFootnote 1 Severity of RxnFootnote 2 | Diagnostic TestsFootnote 3 | Eliciting Dose | Eliciting Allergen | Comments | |||
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1. Canadian Reports | ||||||||||
Yip and Zimmerman, 1999 Canada Full Publication |
5 children Sex: 4 M/1 F Ages: Case 1: 2.5 y M Case 2: 2 y M Case 3: 5 y M Case 4: 7 y F Case 5: 3 y M |
Case 1: Atopic boy w/ Hx of multiple food allergies since 18 month (sesame seed, fish) Case 2: Atopic boy w/ Hx of sen to kiwi, peanut Case 3: boy w/ Hx of BA and multiple food allergies (eggs, sesame, peanuts) Case 4: Atopic girl w/ E since infancy; BA; Allergy to milk, egg and peanut Case 5: boy w/ Hx BA and multiple food allergies |
Case 1: 3 episodes of sev Rxn requiring emergency medical treatment Case 2: 3 episodes of U immediate after exposure to mustard. No mention of emergency Case 3: at least one episode of Ax reaction to fast food (mustard and sesame) Case 4: U and wheezing following ingestion of mustard. No indication of emergency visit Case 5: vomiting, swelling of the lips |
SPT positive for several Mus preparations In 4/5 cases total IgE or mustard specific IgE not reported |
Details not provided |
Mustard sauce |
2/5 Cases Severe One case due to hidden source of mustard in the glazing of a prepared ham & one case in fast food |
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Connors et al., 2006 Canada |
1 female Age: 50 y |
No detailed Hx provided Hx of A type Rxn to Mus |
Symptoms of A after ingestion of Mus |
SPT |
Details not provided |
Fast food Mustard sauce |
Very limited info provided |
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2. International Reports | ||||||||||
Paconesi et al., 1980 Italy |
1 male Age: "young" |
Hospitalization twice in 1 year. Acute giant U with edema of the glottis after eating pizza |
Skin test to Mus antigen extracted from black and white Mus caused intense wheal reaction followed by shock and glottic edema. |
SPT IgE: RAST |
Small amount Mus contaminating the pizza |
Mustard not used in preparation of the pizza: reaction to cross-contamination with Mus |
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Meding, 1985 Sweden |
1 female Age: 40 y |
Atopy Rxn to Mus |
SPT black & white mustard, rape seed & others Cruciferae |
Negative SPT for allylisothiocyanate |
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Widstrom and Johansson, 1986 Sweden |
1 female Age: 25 y |
Hx of allergy to egg and fish in childhood that cleared. |
Acute Rxn to Mus/mayo |
IgE: RAST positive for white & black Mus & rape seed |
One episode of possible cross-contamination of fast food |
Fast food and mayonnaise |
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Vidal et al., 1991 Spain |
2 females Age: Case 1: 47 y Case 2: 15 y |
Case 1: Hx pollen allergy Case 2: Hx of A and pollen allergy |
Case 1: sev U & facial AE w/GI & Res symptoms Case 2: U, facial & throat edema & chest tightness |
Positive STP, Total serum IgE, Specific M IgE |
Mayonnaise and Mus on sandwich and in a salad |
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Monreal et al., 1992 Spain |
1 male & 1 female Age: Case 1: 17y M Case 2: 14y F |
Case 1: family Hx of atopy, personal Hx of IgE dependent BA, allergy to molds and grasses, reocurrent U/AE since age 5 Case 2: family Hx of atopy, personal Hx of BA |
Case 1: Rxn to Mus edema lips/tongue, Dysphagia, Upper Res symptoms Required emergency service Case 2: 1 hr after physical exercise and ingestion of Mus; edema tongue, lips face, U, upper Res distress Required emergency service |
Case 1: STP w/ Mus, aero-allergens positive Case 2: STP for Mus positive |
Both reported as small amount |
Both Mustard sauce |
Compared Severity of Rxn to Mus allergy w/ penicillin. No oral Challenge due to Severity of Rxn |
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Malet et al., 1993 Spain |
2 males Age: Case 1: 31 y Case 2: 32 y |
Case 1: Hypersensitivity to pollen, seasonal R Case 2: No reported Hx of other allergies, Contact Hypersensitivity to Mus since age 10 |
Case 1: AE of face, U, Dyspnea, after oral & nasal exposure to Mus Case 2: U, AE, pruritus, BA after accidental ingestion of Mus, requiring hospital treatment |
Case 1: SPT, total IgE high, Specific IgE by RAST positive to Mus seed Case 2: SPT, total IgE high, specific IgE by RAST to Mus seed |
At least one case of accidental contact to mustard or even the smell of mustard elicited Rxn |
Mustard sauce or seed |
Minimal quantities elicited a dermo- Res Rxn sev enough in one case to require hospitalization |
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Jorro et al., 1995 Spain |
2 male & 1 female Age: Case 1: 43y M Case 2: 17y F Case 3: 19y M |
Case 1: Hx of sev Rxn to Mus & AE to shellfish Case 2: Hx of BA, R, U Case 3: Hx of R |
All 3 cases very severe A requiring urgent hospital service Case 1&2: pruritus, edema of face/tongue, upper Res distress Case 3: upper Res distress, U |
All cases positive SPT & IgE to Mus |
Case 1& 3: Mus sauce Case 2: Mus in salad |
No oral challenge to Mus due to sev of Rxn Oral challenge to others Cruciferae negative |
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Valero et al., 1995 Spain |
3 male & 2 female Age: Case 1: 34y F Case 2: 31y M Case 3: 25y M Case 4: 52y F Case 5: 33y M |
4 cases w/ Hx of Aero-allergy SPT on 86 patients with Hx of atopy |
U, AE, R, Dyspnea, Bronchial spasm |
All 5 cases positive to Mus by SPT & IgE 18.4% of the 86 subjects tested by SPT were positive to Mus |
Mus sauce |
The two cases described earlier in Malet et al., (1993) appear to be included in this case report |
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Kanny et al., 1995 France |
1 female Age: 38 y |
Hx allergy to mustard. |
Oral pruritus Facial edema, U Dyspnea, fainting 20 min after eating Chicken dip |
Positive SPT/ IgE: RAST |
Estimated Concentration of Mustard in the dip: 0.15 mg/100mg |
Chicken dip Hidden source of Mus allergen |
Mus is the most allergenic of the commonly used spices, it is able to induce sev A in very small amounts |
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Frémont et al., 1996 France |
1 female Age: 22 m |
Family Hx atopy |
Failure to thrive |
SPT/IgE positive for Mus, although the culprit food in this case was not Mus |
Milk proteins in flour |
Emphasis on Hidden allergens |
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Asero et al., 2002 Italy |
1 male Age: 54 y |
Hx of A Rxn after ingestion of sunflower seed in bread |
STP positive to Sunflower seeds and Mus |
Sunflower seeds in bread |
Objective of the report was to demonstrate the Cross-reactivity of Sunflower seeds and Mus |
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Lingelbach et al., 2003 Germany |
1 female Age: 40 y |
Hx of food and pollen allergies |
At least two episodes of EIA requiring emergency medical assistance. |
STP, Specific IgE (RAST) |
Fast food |
EIA associated to Mus in food Patient Rejected Oral challenge |
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Aygencel et al., 2007 Turkey |
1 female Age: 53 y |
AE of tongue and oropharynx, Requiring hospital Emergency assistance |
Wild mustard: raw leaves of Brassica (Sinapis) Arvensis in salad |
Abbreviations:
- Ad:
- adult
- CH:
- challenge
- Ch:
- children
- DBPCFC:
- double-blind ,placebo-controlled food challenge
- F:
- female
- Hx:
- history
- LFC:
- labial food challenge
- M:
- male
- max:
- maximum
- min:
- minute
- mod:
- moderate
- Mus:
- mustard
- OC:
- occupational
- OFC:
- oral food challenge
- Res:
- respiratory
- Rxn:
- reaction
- Sen:
- Sensitization
- SEV:
- severity
- sev:
- severe
- SBPCFC:
- single-blind, placebo-controlled food challenge
- SUB:
- subjects
- w/:
- with
- ( y)
- years old
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