The skin prick test results to saffron, sumac and barberry in patients with atopy

Background: Food allergens appear to play a role in the etiology and deteriorating of atopy in some patients, little is known about hypersensitivity to some common food additives in these patients. The purpose of this study was to identify probable sensitization to saffron, sumac and barberry in patients with atopy.

Materials and Methods: This cross- sectional study included 390 patients with atopy and 300 healthy individuals with no history of atopic diseases. Skin tests were performed in both patient and control group with saffron, sumac and barberry.

Results: A positive skin test to saffron was seen in 61 (15.6%), to sumac in 29 (7.4%) and to barberry in 36 (9.2%) patients with atopy. None of individuals in control group showed sensitization to three studied extracts.

Conclusion: The results of the present study revealed sensitization to saffron, sumac and barberry in patients with atopy. A further research with food challenges is required to confirm food allergy in those patients with sensitization to saffron, sumac and barberry.

Introduction

Allergens are primarily proteins, capable of stimulating IgE synthesis in genetically susceptible people. They enter to human body by inhalation, contact and ingestion. These allergens may induce allergic diseases such as asthma, Allergic Rhinitis (AR) and Atopic Dermatitis (AD). Ingested allergens are thought to play an important role in the development and worsening the clinical symptoms in patients with atopy [1-3].

Saffron (Crocus sativus) is a kind of cooking spice that cultivated in some parts of Iran and near the studied area. It’s now an essential part of some Eastern, Middle Eastern, and European dishes. It is expensive because only a small amount of each saffron flower is used and all harvesting must be done by hand. Clinical allergic symptoms to saffron are reported in eye, nose and respiratory system through an IgE-dependent mechanism [4,5].

Sumac (Rhus coriaria) in form of dried and powdered fruits is widely used in Asian countries. It is essential ingredient in Middle Eastern cooking. Sumac has been served as acidic taste in cooking prior to the introduction of lemons by the Romans. The reactions to sumac present as dermatitis in children and occupational disease [6,7].

Barberry (Berberis vulgaris) as a sharp acid flavor is used the most is Iran. Berberis vulgaris grows in the wild in much of Europe and West Asia. They are used in jams, a common flavoring for soft drinks and Persian rice with sugar. This plant is considered mostly allergy free and causes little or no allergy problems in people [8].

Skin prick test (SPT) is a primary test for the diagnosis of IgE‑mediated food allergy and it is safe, inexpensive, informative, and easy to perform [9].

A number of patients with atopy describe clinical allergic symptoms after ingestion of some ingredients of foods. This study was designed to investigate how much saffron, sumac, and barberry may elicit positive skin test in patients with atopy in compared with control group.

Methods and Materials

This cross-sectional study was performed on 390 patients with atopy and 300 individuals without atopy from June to November 2016. All the patients were from southwestern Iran who was regularly referred to an allergy clinic at Namazee Hospital affiliated to Shiraz University of Medical Sciences, Iran. The diagnosis of asthma was based on the Expert Panel Report 3, AR according to allergic rhinitis and its impact on asthma and AD based on the criteria of Hanifin and Rajka in order with the supervision of allergist [10-12]. Clear, watery discharge and itching in the eyes were considered allergic conjunctivitis and the timeline of 6 weeks of daily or nearly daily urticaria was considered as chronic urticaria [13,14].

The study protocol was approved by the Ethics Committee of Shiraz University of Medical Sciences (93-8302), and informed consent was obtained from patients and control individuals after the study was described in detail.

Demographic data including sex, age and type of atopy (allergic rhinitis, asthma, chronic urticaria, allergic conjunctivitis) were collected. Preparation of extract of saffron, sumac and barberry was done based on modified method of Kwaasi, et al., [15,16]. SPT were performed on the forearms using manufactured extracts of saffron, sumac and barberry and the results were measured 15 minutes after application. The tests were considered positive sensitization when wheal diameter was ≥ 3 mm greater in diameter than the negative control in response to the extract after 15 min application. Histamine (10 mg/mL) and saline were used as positive and negative controls, respectively. Antihistamine medications were stopped 7 days before the skin prick tests in all individuals.

Results and Discussion

Three hundred and ninety patients (233 females and 157 males) with atopy ranging in age from 10 to 50 years (mean age 30.63±10.72) were enrolled in the study. Three hundred individuals (205 female and 95 male) ranging in age between 15 and 52 years (mean age 31.27±10.22) were included as control group. There were no significant differences for sex and age between the two groups.

A positive skin test to saffron was seen in 61 (15.6%), to sumac in 29 (7.4%) and to barberry in 36 (9.2%) patients with atopy. None of individuals in control group showed sensitization to three studied extracts. There was no relationship between sensitization to extract of each saffron, sumac and barberry with age and sex in these patients.

Positive sensitization to saffron extract reported 12.5% (21/167) in saffron workers of Khorasan (Iran), this rate is near similar to our patients with atopy [5]. An earlier study showed sensitization to saffron in Spanish saffron workers 6% and in atopic patients 4.2% [17]. Saffron is commonly grown in Spain similar to Iran for commercial purposes; sensitization is higher in Iranian than Spanish patients. There is no sufficient data for comparison of sensitization rate to sumac and barberry in patients with atopy in the literature.

Table 1 shows type of atopy and the number of patients with positive sensitization to saffron, sumac and barberry.

Positive sensitization to three studied allergen was 27.3% (32/117) in patients with allergic rhinitis, 28.1% (43/153) in asthmatic patients and 55.8% (24/43) in individuals with asthma& allergic rhinitis. Having both asthma and allergic rhinitis show severity of atopy, therefore, it causes more chance for sensitization to allergens.

From 73 patients with chronic urticaria 32.8% (24/73) showed sensitization to studied food allergens. Contrast our result; Rajan JP, et al., study reported food additives are a rare cause for chronic urticaria by doing double-blind placebo-controlled food challenge. [18].

We had 4 patients with allergic conjunctivitis, 2 had positive reaction to saffron and one to sumac. It is better considering SPT to studied food allergens in those patients with allergic conjunctivitis, although the number of our patients was small.

Positive skin test is not enough to confirm the presence of allergic disease, however; it shows allergic sensitization which may predict the subsequent onset of allergic symptoms. It is noticeable that cross‑reactivity with other allergens may elicit positive skin test in individuals with no clinical symptoms.

The results of the present study revealed sensitization to saffron, sumac and barberry in patients with atopy. Food challenges are considered the gold accurate standard method for diagnosing food allergy; however, this procedure requires cooperation of the patient and preparation of the office for the challenge. The major limitation of this study is need to food challenge for establishing allergy to saffron, sumac and barberry.

Authors’ contributions

All authors contributed to this project and article equally. All authors read and approved the final manuscript.

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