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The Evolving Study of Cannabis Allergies

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The AAAAI 2022 meeting featured a session on “Allergic Disease Triggered by Cannabis Production and Consumption.” The “Spectrum of Allergic Disease” was presented by Ine Decuyper MD PhD, from University of Antwerp, Belgium, whose work with Didier Ebo MD has extensively explored the association with nsLTP (non-specific lipid transfer proteins) driven allergies and cross-reactivity with other food allergies. Did you know that the cannabis Can s 3 protein is a nsLTP found also in many fruits and vegetables such as peaches and other stone fruits, peanuts, hazelnuts, as well as latex and tobacco? There is a hemp derived sIgE being developed presently for RUO (Research Use Only).

Karin Pacheco MD MSPH, from the National Jewish Health in Denver, discussed “Establishing the Diagnosis of Cannabis Allergy” in light of there being no standardized commercial extracts available given its continuing federal DEA Schedule I status (drugs with no currently accepted medical use and a high potential for abuse), despite its legalization medical and/or recreational in 37 states, and the District of Columbia. For now, skin prick testing with flower extracts derived by mortar & pestle “puddle testing” is the only available test. Patients may need to bring in their own cannabis, and then, there are legality issues. In addition to the Can s 3 nsLTP major allergens, other minor allergens are now classified with profilin as Can s2, the oxygen-evolving enhancer protein as Can s4, and the Pathogenesis related protein 10 homolog as Can s 5.

William Silvers, MD, wrapped up the discussion by addressing “Exposures in Marijuana Grow Operations and Stores.” He delivered a historical perspective on the increasing prevalence of cannabis allergies and the work of the International Cannabis Allergy Collaboration, with its publication last month of “Cannabis-related allergies: An international overview and consensus recommendations” in the journal ALLERGY. Dr. Silvers, Clinical Professor of Medicine at the University of Colorado School of Medicine, is chair of the “International Cannabis Allergy KAP (Knowledge, Attitudes, Practices) Collaboration,” a joint endeavor of the American College of Allergy Asthma Immunology, the European Academy of Allergy Clinical Immunology, and the Canadian Society of Allergy Clinical Immunology, and is Chief Scientific Officer of the Canna Research Foundation. He discussed the increased exposure and sensitization seen in the marijuana indoor and outdoor cultivation operations, not only to the cannabis itself but also to potential mold and pesticide contamination. He comments that “it is important for all allergists to become more knowledgeable about cannabis allergy, which is on the rise given its greater legalization, exposure, and therefore sensitization in the atopic population.”

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