ARCHIVED - Tables - Garlic and Onions: Insufficient Evidence to Include on the List of Priority Food Allergens in Canada: A Systematic Review [Health Canada, 2009?]

Table 1: Clinical Studies (Grouped by relevance to garlic, onion and both garlic
and onion & organized chronologically by publication date within groups)
Author, Year, Country Study Design Details Subjects Clinical History Symptoms & Signs Footnote 1 (before challenge) Symptoms & Signs Footnote 1 Severity of Rxn Footnote 2 after Challenge Diagnostic Tests Footnote 3 Eliciting Dose Eliciting Allergen Prevalence Comments
Garlic
Rancé and Dutau, 1997 France

Open study assessing over 25 allergens including garlic using SPT, prick + prick test IgE

LFC and SBPCFC (when LFC negative)

142 SUB (Ch)

Age: 7m - 15y
Ave - 4.6 y

Sex: 95M: 47F

Hx of food allergy

Multiple presenting symptoms in 66% Ch

AD 61%
Rash 32%
AE 25%
BA 24%
A 4%

Positive Rxn to garlic 1/142 in LFC SPT, prick + prick test, IgE

1 mg to 5 g for all allergens tested

Further details were not provided

Commercial extract and extract from fresh foods 1/142 (1%) positive for garlic allergy LFC No comments relevant to garlic
Rancé and Dutau, 2002 France Open allergy study assessing foodstuff including garlic documented by DBPCFC in BA SUB identified by pulmonary function

163 SUB (Ch)

Age: 2 - 17 y
Ave - 7.2 y

Sex: 109M: 54F

Family Hx atopy 91%

Hx of ≥ 1 food allergies

BA for Ave 5.5y

SK 59%
RP 24%
GI 12%

Asthma induced by food allergens potentially severe

6% of SUB reported A Rxn

SPT
IgE

Details not provided

Various food extracts

Further details not provided

Positive allergy to garlic 1% SUB Prevalence of asthma induced by food allergens: 10%
Onion
Valdivieso et al., 1994 Spain SPT for onion performed on 106 SUB randomly chosen from allergy clinic, Positive responders participated in one or more of the following: bronchial or nasal provocation, double-blind oral provocation, IgE (RAST)

106 SUB randomly chosen from allergy clinic;

8 SUB positive SPT Rxn (8%)

4/8 SUB has clinical symptoms to onion exposure

Age: 31-45 y

Sex: 1M: 3F

Hx of food and pollen allergies

Pollen or onion induced:
RC (4/4)
D (2/4)
E (1/4)
BA (2/4)

2 SUB had intense RC and 1 SUB  had chest tightness, wheezing and D after exposure to smell of onions

Oral provocation in 2 SUB did not elicit a Rxn

SPT 106 SUB

Bronchial provocation 2 SUB

Nasal Provocation 1 SUB

Double-blind oral provocation 2 SUB

SPT - 516µg protein/ml

Bronchial & Nasal - 1:1 v/v onion extract

Oral - 2 g onion powder

Fresh onion, onion powder

8 SUB (8%) positive SPT

3/8 SUB positive IgE onion

4/8 SUB Pollen-specific IgE

2/4 SUB garlic-specific IgE

4 Sub had immediate positive SPT to fresh onion, garlic, fried onion and leek.

All showed positive reaction to heated and non-heated onion extract

Results suggest respiratory allergy

Garlic and Onion
Boccafogli et al., 1994 Italy Open study assessing frequency of food-induced symptoms or allergy in SUB monosensitized to grass pollen SPT, MAST-CLA & oral challenge (0.45 mg food administered w/ 10-fold increase in 30 min intervals until cumulative dose of 5 g if no Rxn observed administration up to 50 g in 30 min intervals

169 SUB monosensitize to grass pollen

Age: 9 - 54 y
Mean 28 y
Sex: 84M: 85F

Control 50 SUB monosensitize to Derma-tophagoides

Age: 10 - 52 y
Mean 30.5 y
Sex: 25M: 25F

Hx of BA and/or R during grass pollen season or household dust

Positive SPT, MAST-CLA and nasal challenge for aero-allergens

Pollen group had increased frequency of adverse food Rxn 81/169 (48%) compared to control 3/50 (6%)

Symptoms:
U 28/169 (17%)
GI 28/169 (17%)
Res 13/169 (8%)

Garlic and onion mainly associated w/ U & GI symptoms

19/169 SUB (11%) considered to have food allergies
1/19 garlic
1/19 onion

46/169 SUB (27%) considered to have food intolerance
6/46 garlic
4/46 onion

SPT

MAST-CLA

Oral challenge

Details not provided

Garlic & Onion

No further information provided

19/169 SUB (11%) considered to have food allergies

1/169 garlic (0.5%)

1/169 onion (0.5%)

(IgE sensitized, OAS, GI and/or U/AE within 2 hours after ingestion of small quantity)

Number of SUB with food intolerance higher than that of SUB w/ food allergy

Cross reactivity between pollen allergens and food allergens may explain food allergy association but not higher incidence of food intolerance, increased intestinal permeability to macro-molecules hypothesised

Romano et al., 1995 & 1998 Italy

Retrospective Food-dependent EIA study in SUB with Hx of EIA within 2 hours after meal

26 food allergens tested by SPT, IgE assay

8/14 SUB participated in food-exercise challenge

14 SUB w/ Hx of food-EIA

Age: 16-27 y
Mean (20.5±3.6)

Sex: 10M: 4F

Family Hx of allergy 50%

Hx pollen allergy 29%

Hx of A

14/14 allergic to 2 or more food allergens

10/14 positive for onion and 9/14 positive for garlic by SPT/IgE specific levels

1 SUB participated in food-exercise challenge after consuming garlic - no Rxn observed

SPT

RAST (IgE)

Not provided Onion or garlic no further details provided

10/14 (71%) positive for onion

9/14 (64%) positive for garlic

No Rxn observed after garlic-exercise challenge; Onion not tested

Hx data less helpful interpreting positive SPT/RAST for garlic, onion, parsley & basil because patients could not recall if they were part of the EIA - meal

Asero et al., 2007 Italy

Open allergy study assessing vegetable foods including garlic and onions to identify which vegetables are safe for lipid transfer protein-(LTP) allergic SUB to consume

49 SUB (mono-sensitized to LTP)

Age: mean 29 y

Sex: 21M: 28F

Controls:
24 sensitized to birch pollen
18 sensitized to profilin
16 sensitized to LTP & birch pollen

Hx of Rx to vegetables including garlic and onions

Hx of

OAS
U
AE
BA
A

No SUB reported Hx of allergy to garlic

2/49 (4%) reported Hx of allergy to onion

8/36 (22%) SUB positive SPT to garlic

16/41 (39%) SUB positive SPT to onion

4/13 (31%) controls positive SPT to garlic

6/14 (43%) controls positive SPT to onion

Results not considered statistically significant

SPT No provided

Commercial vegetable food extracts

No further details provided

8/36 (22%) SUB positive SPT to garlic

16/41 (39%) SUB positive SPT to onion

4/13 (31%) controls positive SPT to garlic

6/14 (43%) controls positive SPT to onion

Results not considered statistically significant

Specificity of SPT poor, many patients showed positive SPT to foods that they reported eating without any problems, including garlic and onions
Table 2: Other Relevant Studies (Grouped by relevance to garlic, onion and both garlic and onion & organized chronologically by publication date within groups)
Author, Year, Country Study Design Details Subjects Clinical History Symptoms & Signs Footnote 1 (before challenge) Symptoms & Signs Footnote 1 Severity of Rxn Footnote 2 after Challenge Diagnostic Tests Footnote 3 Eliciting Dose Eliciting Allergen Prevalence Comments
Onion
Avila-Castanon et al., 2002 Mexico Retrospective analysis of 1419 SUB w/ food allergies to determine frequency of hypersensitivity to foods

1419 SUB (Ch)

Age: 12m - 18 y
Ave - 12.8 y

Sex : details not provided

Hx of food allergies

Most allergy affect age groups:

4-7y (49%)
1-3y (24%)
12-17y (14%)

No applicable to study design SPT Details not provided

Onion

Further details not provided

4% SUB positive SPT to onion Onion identified in group of foods responsible for 58% of allergic Rxn (fish, milk, seafood, soy, beans, orange, onion, tomato, chicken, nut, lettuce and strawberry)
Garlic and Onion
André et al., 1994 France Retrospective analysis of 9 y period investigating foodstuff most frequently associated with A Rxn

580 SUB

480 Ad
100 Ch

Age: 1-83 y
Mean- 30 y

Sex:
290M: 290F

Hx of adverse Rxn to food

60/580 (10%) SUB Hx sev Rxn to food

A 52/60 (87%)
AE 6/60 (10%)
Bronchospasm 2/60 (3%)

Not applicable to study design

SPT
IgE

Details not provided Garlic & Onion Garlic & Onion were not among the top 19 foods most frequently associated with A Rxn (celery 18% to camomile 1%)

Evolution of sensitization over 1984-1992 indicate an overall increasing trend for garlic and onions

Increased consumption and more attentive clinical examinations are credited for this evolution

Moneret-Vautrin et al., 2002 Country not cited

Retrospective analysis of a food allergy database (589 SPT)
and 1 Case report of onion allergy (case 1)

1 SUB (case 2) DBPCFC for garlic

1 SUB (case 3) SBPCFC for garlic

1 SUB (case 4) LFC for garlic

Food allergy database 589 SUB:

402 Ch

Age: < 15 y

187 Ad

Age: not reported

Sex: not reported

Hx of food allergy

Case 1 w/ systemic mastocytosis & A induced by celery, carrot, onion, hazelnut

Case 2 w/ U & AE

Case 3 w/ R, BA, & U from fruits and vegetables

Case 4 w/ U & A from garlic and onion soup

Case 1: no challenge reported

Case 2: U after 45 min SEV: mild

Case 3: laryngeal pruitus, rhinorrhea, cough SEV: mild-mod

Case 4: positive LFC result

SPT, DBPCFC, SBPCFC, LFC

Case 2: 1000 mg garlic

Case 3: 500 mg garlic

No details provided about garlic used in challenge reports

20/265 positive SPT for garlic (8%)

7/263 positive SPT for onion (3%)

In this series, 2 spices responsible for half cases observed: garlic and fennel seed
Table 3: Case Reports (Grouped by relevance to garlic and onion & organized chronologically by publication date within groups)
Author, Year, Country Cases Clinical History Symptoms & Signs Footnote 1
Severity of Rxn Footnote 2
Diagnostic Tests Footnote 3 Eliciting Dose Eliciting Allergen Comments
Garlic
Burden et al., 1994 United Kingdom

1 male

Age: 58 y

Sev SK Rxn on the hands after taking garlic extract

Double-blind oral provocation w/ garlic tablets once daily for a week result D of the hands; no Rxn to placebo

SEV: mild

Oral Challenge Not provided Garlic extract & garlic tablet Lack of systemic Rxn reported when garlic is ingested by SUB w/ contact allergy may either be dose-related or due to the relevant antigens being heat-liable and destroyed by cooking
Asero et al., 1998 Italy

1 female

Age: 35 y

Hx of systemic U/AE associated with both raw and cooked garlic
No Hx of pollen allergy or to other common food allergens

U/AE but no GI symptoms reported after ingestion of garlic

SEV: mild

SPT Not provided commercial garlic extract & fresh garlic

In a series conducted by this author w/ over 300 SUB w/ both pollen allergy and OAS no SUB reported garlic intolerance, suggest lability of cross-reactive antigen

No GI symptoms of this case suggest garlic allergens destroyed by enzymatic digestion

Perez-Pimiento et al., 1999 Spain

1 female

Age : 23 y

Hx of allergy to pollen and dried fruit and food-dependent EIA

An A Rxn after eating young garlic, emergency medical treatment was required

SEV: sev

SPT
Prick+Prick
IgE

Not provided Young garlic (unripe garlic) SUB tolerated garlic cloves and other Liliaceae but was sensitized to pollen and foods distantly related to garlic
No oral challenge (sev Rxn)
Pries et al., 2002 Portugal

1 male

Age: 16 m

Hx of milk and egg white allergy

Hx of tolerance of cooked garlic and onion

Oral challenge with raw garlic positive generalized U

SEV: mild

Oral challenge with cooked garlic negative

SPT
Prick+prick

Not reported commercial garlic extract & fresh garlic Suggest allergic fraction that this case is sensitized to is denatured by heat
Yin and Li, 2007 China

Case 1: 1 male

Age: 42 y

Case 2: 1 female

Age: 16 y

Both case had Hx of hay fever

Case 1: an A Rxn after eating young garlic (U, AE, throat swelling, D, syncope and hypertension)

Case 2: an A Rxn while walking for 10 min after eating young garlic (EIA)

SPT
IgE for various foods

No reported Young garlic Limited detail provide in the abstract. Challenge study refused by subjects.
Onion
Hicks & Tanner, 1998 USA

1 male

Age: 27 y

Hx of food-dependent EIA requiring emergency medical attention

EIA (lightheadedness, generalized pruritus, numbness in jaw, facial swelling)

Played basketball after eating

SEV: sev

SPT positive for corn, soybeans, peanuts, walnuts, cabbage & onion

Self-conducted oral challenge with chicken, peanut, potatoes & onion negative w/out exercise challenge

Not provided Several foods including onion Challenge to cooked onion not performed

Arena et al., 2000

Spain

1 female

Age: 44 y

No Hx of allergies to areo-allergens or other foods

An A Rxn after eating raw/lightly-cooked onion

SEV: sev

Onion-specific IgE

Positive for raw onion, negative for cooked onion

Not provided Raw onion

SUB sensitized to thermolabile antigenic fraction of onion.

Cooked onion tolerated

Asero et al., 2001 Spain

1 male

Age: 45 y

Hx of OAS and gastric pain after ingesting peaches

Sev systemic U/AE Rxn after eating raw onion

SEV: mod

Tolerate cooked onion

SPT

Onion-specific IgE

Total IgE positive

Not provided Raw onion No reaction to cooked onion
Perez-Calderon et al., 2002 Portugal

1 female

Age: 26 y

Hx of RC & BA due to pollen allergies

Several episodes of A type Rxn after eating onion and exercising (EIA), at least one episode requiring emergency medical treatment

SEV: sev

SPT
Prick+prick
Total IgE positive

FC at rest negative

FC w/ cooked onion positive after exercise 10 min, 2-hours after eating

30 g cooked onion Raw & Cooked onion Observed cross-reactivity w/ other members of the Lilaceae family (garlic, asparagus or leek)
Enrique et al., 2007 Spain

1 female

Age: 19 y

Hx of RC and U to mugwart and oral pruritus after eating raw onion and peach

U after eating raw onion

SEV: mild

SPT

Onion-specific IgE positive

Not provided Raw onion Cooked onion extract not tested
Garlic and Onion
Belleau and Blaiss, 2007 USA

1 male

Age: 5 y

Hx of perennial allergic R, atopic dermatitis, mild intermittent asthma, egg and peanut allergy An A Rxn requiring medical intervention after consuming steak seasoned with "Kraft Greek Vinaigrette Dressing"

SPT positive for peanuts, kraft dressing, whole egg, garlic

RAST positive for garlic, onion and various foods

Not provided Garlic and onion in salad dressing Challenge study considered inappropriate based on severity of Rxn.

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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