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Exploring the Diagnosis and Profile of Cannabis Allergy

Published:September 28, 2018DOI:https://doi.org/10.1016/j.jaip.2018.09.017

      Background

      Cannabis allergy (CA) has mainly been attributed to Can s 3, the nonspecific lipid transfer protein (nsLTP) of Cannabis sativa. Nevertheless, standardized diagnostic tests are lacking and research on CA is scarce.

      Objective

      To explore the performance of 5 cannabis diagnostic tests and the phenotypic profile of CA.

      Methods

      A total of 120 patients with CA were included and stratified according to the nature of their cannabis-related symptoms; 62 healthy and 189 atopic controls were included. Specific IgE (sIgE) hemp, sIgE and basophil activation test (BAT) with a recombinant Can s 3 protein from Cannabis sativa (rCan s 3), BAT with a crude cannabis extract, and a skin prick test (SPT) with an nCan s 3-rich cannabis extract were performed. Clinical information was based on patient history and a standardized questionnaire.

      Results

      First, up to 72% of CA reporting likely-anaphylaxis (CA-A) are Can s 3 sensitized. Actually, the Can s 3-based diagnostic tests show the best combination of positive and negative predictive values, 80% and 60%, respectively. sIgE hemp displays 82% sensitivity but only 32% specificity. Secondly, Can s 3+CA reported significantly more cofactor-mediated reactions and displayed significantly more sensitizations to other nsLTPs than Can s 3-CA. Finally, the highest prevalence of systemic reactions to plant-derived foods was seen in CA-A, namely 72%.

      Conclusions

      The most effective and practical tests to confirm CA are the SPT with an nCan s 3-rich extract and the sIgE rCan s 3. Can s 3 sensitization entails a risk of systemic reactions to plant-derived foods and cofactor-mediated reactions. However, as Can s 3 sensitization is not absolute, other cannabis allergens probably play a role.

      Key words

      Abbreviations used:

      BAT (Basophil activation test), CA (Cannabis allergy), CA-A (Likely-anaphylaxis to cannabis), CA-C (Cutaneous symptoms to cannabis), CA-R (Respiratory symptoms to cannabis), CA-RC (Localized respiratory and cutaneous symptoms to cannabis), CBA (Cytometric bead array), CS (Cannabis sativa), HC (Healthy controls), NPV (Negative predictive value), nsLTP (Nonspecific lipid transfer protein), P+LTP− (Atopic pollen-sensitized participants without an nsLTP sensitization), P+LTP+ (Atopic pollen and nsLTP-sensitized participants), PPV (Positive predictive value), rCan s 3 (Recombinant Can s 3 protein from CS), sIgE (Specific IgE), SPT (Skin prick test)
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