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Abstract
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. (C) 2018 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
Keywords
Immunology and Allergy, Cannabis allergy, Diagnosis, BAT, Specific IgE, Skin prick test, Can s 3, nsLTP, Cofactor, Basophil, Anaphylaxis, Hemp, LIPID TRANSFER PROTEIN, SENSITIZATION, SATIVA

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MLA
Decuyper, Ine Ilona, et al. “Exploring the Diagnosis and Profile of Cannabis Allergy.” JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, vol. 7, no. 3, 2019, pp. 983-989.e5, doi:10.1016/j.jaip.2018.09.017.
APA
Decuyper, I. I., Van Gasse, A. L., Faber, M. A., Elst, J., Mertens, C., Rihs, H.-P., … Ebo, D. G. (2019). Exploring the diagnosis and profile of cannabis allergy. JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, 7(3), 983-989.e5. https://doi.org/10.1016/j.jaip.2018.09.017
Chicago author-date
Decuyper, Ine Ilona, Athina Ludovica Van Gasse, Margaretha A. Faber, Jessy Elst, Christel Mertens, Hans-Peter Rihs, Margo M. Hagendorens, et al. 2019. “Exploring the Diagnosis and Profile of Cannabis Allergy.” JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 7 (3): 983-989.e5. https://doi.org/10.1016/j.jaip.2018.09.017.
Chicago author-date (all authors)
Decuyper, Ine Ilona, Athina Ludovica Van Gasse, Margaretha A. Faber, Jessy Elst, Christel Mertens, Hans-Peter Rihs, Margo M. Hagendorens, Vito Sabato, Hilde Lapeere, Chris H. Bridts, Luc S. De Clerck, and Didier Gaston Ebo. 2019. “Exploring the Diagnosis and Profile of Cannabis Allergy.” JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 7 (3): 983-989.e5. doi:10.1016/j.jaip.2018.09.017.
Vancouver
1.
Decuyper II, Van Gasse AL, Faber MA, Elst J, Mertens C, Rihs H-P, et al. Exploring the diagnosis and profile of cannabis allergy. JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE. 2019;7(3):983-989.e5.
IEEE
[1]
I. I. Decuyper et al., “Exploring the diagnosis and profile of cannabis allergy,” JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, vol. 7, no. 3, pp. 983-989.e5, 2019.
@article{8667762,
  abstract     = {{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. (C) 2018 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology}},
  author       = {{Decuyper, Ine Ilona and Van Gasse, Athina Ludovica and Faber, Margaretha A. and Elst, Jessy and Mertens, Christel and Rihs, Hans-Peter and Hagendorens, Margo M. and Sabato, Vito and Lapeere, Hilde and Bridts, Chris H. and De Clerck, Luc S. and Ebo, Didier Gaston}},
  issn         = {{2213-2198}},
  journal      = {{JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE}},
  keywords     = {{Immunology and Allergy,Cannabis allergy,Diagnosis,BAT,Specific IgE,Skin prick test,Can s 3,nsLTP,Cofactor,Basophil,Anaphylaxis,Hemp,LIPID TRANSFER PROTEIN,SENSITIZATION,SATIVA}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{983--989.e5}},
  title        = {{Exploring the diagnosis and profile of cannabis allergy}},
  url          = {{http://dx.doi.org/10.1016/j.jaip.2018.09.017}},
  volume       = {{7}},
  year         = {{2019}},
}

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