Spice allergy may be an overlooked cause of pediatric anaphylaxis, particularly when symptoms occur during cooking rather than after eating, according to a recent case report and literature review.
Researchers described the first reported case of cumin-induced anaphylaxis caused by inhalation in a patient aged younger than 18 years. Data on anaphylactic episodes triggered by spice inhalation remain limited despite increasing exposure to spices in processed foods and diverse dietary patterns. They noted that prick-by-prick (PbP) testing with spice powders may help improve the diagnostic workup when allergy is suspected.
In the study, the researchers used PubMed, MEDLINE, and EMBASE to identify case reports, case series, retrospective studies, and prevalence studies describing allergic reactions after spice ingestion or inhalation that were published between January 1989 and March 2024. The review identified only isolated pediatric cases involving coriander, curry, fenugreek, mustard varieties, pepper, and other spices.
Data cited in the review showed that spices accounted for 4% of 1,970 anaphylaxis cases in children aged 0 to 17 years in a 2016 European registry and for 0.7% of 4,468 food-induced cases in a 2023 analysis. A retrospective study from China identified spices as the trigger in about 1.7% of 1,501 anaphylaxis cases among children and adults.
The patient included in the case study was a 17-year-old girl with asthma, allergic rhinitis, and immunoglobulin E (IgE)-mediated food allergy. She reported recurrent itching, rhinitis, sneezing, and facial flushing during airborne cumin exposure while meals were prepared since 3 years of age. At age 17, cumin inhalation during meal preparation precipitated dyspnea, generalized pruritus, flushing, lip and eye angioedema, and bilateral wheezing. On presentation to the emergency department, her oxygen saturation was 93%.
Treatment with intramuscular epinephrine, intravenous chlorphenamine, hydrocortisone, and an intravenous saline solution led to complete symptom resolution within 3 to 4 hours. At 1-month follow-up, PbP testing with ground cumin produced a 9-mm wheal, confirming sensitization. Because of the severity of the reaction, oral challenge testing was not performed, and the patient was prescribed an epinephrine autoinjector and advised to avoid cumin and kiwi.
The review highlighted gaps in current diagnostic approaches. The researchers noted that frequent inaccuracies in spice labeling under current regulations, particularly in processed foods and ethnic dishes. This often obscures ingredients that may act as inhalational and ingested allergens. The researchers cited data showing that among 589 children with food allergy, 32% had positive prick tests to Apiaceae spices, including a 20% positivity rate for cumin. However, clinically confirmed spice allergy remained uncommon.
The researchers emphasized that better skin testing standardization is necessary to minimize false-positive results. Serum IgE testing is often insensitive, and newer approaches such as multiplex and basophil activation tests require further validation before routine clinical use.
"Clinical history should always guide subsequent investigations, and spice allergies in children may be difficult to suspect unless careful anamnestic investigation is performed," wrote lead study author Benedetta Pessina, MD, of the Pediatric Unit at the Rho and Garbagnate Milanese Hospital in Italy, and colleagues
Co–study author Mattia Giovannini reported personal fees from Sanofi and Thermo Fisher Scientific, and Simona Barni reported speaker fees from Nutricia, Sanofi, and Firma. The study authors reported no other conflicts of interest.
Source: Frontiers in Immunology
