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Anaphylaxis caused by linseed (flaxseed) intake

1996; Elsevier BV; Volume: 98; Issue: 2 Linguagem: Inglês

10.1016/s0091-6749(96)70175-6

1097-6825

L. Alonso, M. L. Marcos, Juan Blanco, J. A. Navarro, S. Juste, M Garcés, Rossío Carmen Ayaviri Pérez, P. J. Carretero,

Phytoestrogen effects and research

Flax is a plant that belongs to the Linaceae family. It comes from Central Asia, and it has been cultivated for 5000 years. Egyptians, Hebrews, Greeks, and Romans used the seeds as food and the fibers to weave clothes, sails, and other items. Nowadays, linseed oil is extracted from this plant, and this oil is mainly used in the preparation of varnish, paint, linoleum, and soap. Linseed oil has recently been used as a laxative.1Merier P Seiler W Stahelin H. Bulk-forming agents as laxatives in geriatric patients.Schweiz Med Wochenschr. 1990; 120: 314-317PubMed Google Scholar We report the case of a 40-year-old woman who had an anaphylactic reaction after the intake of linseed oil. A 40-year-old woman with no personal or familial history of atopy took linseed oil as a laxative. Ten minutes after the intake of the first spoonful, she experienced ocular pruritus and weeping, followed by strong palmar pruritus and generalized urticaria, nausea, and vomiting. She was treated in the emergency department, and the symptoms were promptly reversed. Skin prick tests were done with a battery of commercially available allergens (Laboratory Ifidesa-Aristegui, Bilbao, Spain), which included: Dermatophagoides pteronyssinus, D. farinae, Lepidoglyphus destructor, Glycyphagus domesticus, Aspergillus fumigatus, Penicillium notatum, Alternaria tenuis, Cladosporium herbarum, grass pollen mix, animal allergens, feathers, cockroach, latex, and food. A linseed extract was prepared as follows: 5 gm of linseed was incubated in 50 ml of phosphate-buffered saline for 24 hours at 4° C with continuous stirring. After straining the extract through filter paper, the solution was passed through a Millipore filter (0.22 μm; Millipore Corp., Bedford, Mass.). Skin prick tests were done with the antigenic preparation described previously. The positive control was histamine, 10 mg/ml, and the negative control was phosphate-buffered saline. Our extract was also tested in five atopic and five nonatopic patients. The total IgE antibody was determined by CAP System (Phadebas; Kabi Pharmacia, Uppsala, Sweden). The determination of specific IgE for linseed was performed by coating the allergen (2 mg/disk) to cellulose disks activated by CNBr. A Pharmacia-Trazer kit (Kabi Pharmacia) was used during the development process. We also performed sodium dodecylsulfate–polyacrylamide gel electrophoresis (SDS-PAGE) of linseed extract by the Laemmli discontinuous method and SDS-PAGE immunoblotting with the patient’s serum and a nonallergic patient control serum. For ethical reasons, we did not perform the oral provocation with linseed. A skin test response to linseed extract was considered positive when a wheal with a diameter of 12 mm was produced. The positive control was 6 mm. There was no later reaction. None of the tested control subjects showed any skin reaction. Results were negative for the rest of the allergens tested. Total IgE antibody was 19 kU/L. Specific IgE antibody determination to linseed showed a value of 2.16 Phadebas RAST units/ml (grade 2 to the reference standard rate). The result of SDS-PAGE shows 15 visible bands between 58 kd and 13 kd. Immunoblot of SDS-PAGE was made with linseed extract and patient serum. It showed five allergens with molecular weights of 38, 35, 30, 22, and 20 kd. Flax (Linum usitatissimum) is an important cause of respiratory disease. Non-IgE-mediated byssinosis, caused by inhalation of dust in the processing of flax, has been described in flax workers,2Nowier M El-Sadik Y El-Dakhakhny A Osmar H. Dust exposure in manual flax processing in Egypt.Br J Ind Med. 1975; 32: 147-152PubMed Google Scholar as well as IgE-mediated occupational asthma in the processing of linseed oil.3Bernstein D Bernstein I. Occupational asthma.in: 3rd edition. Allergy: principles and practice. CV Mosby Company, St Louis1988: 1197-1218Google Scholar Flaxseed hypersensitivities were described by two different authors in the 1930s.4Black WC. Flax hypersensitiveness.JAMA. 1930; 94: 1064Crossref Scopus (8) Google Scholar, 5Grant LR. A report of six cases of flaseed sensitization with review of the literature.J Allergy. 1931; 3: 469-477Abstract Full Text PDF Scopus (5) Google Scholar Linseed contains potent allergens.6William R Kenneth P. Aerobiology and inhalant allergens.in: 3rd edition. Allergy: principles and practice. CV Mosby Company, St Louis1988: 312-372Google Scholar Exposure to these allergens can occur through the oral route (e.g., linseed infusion; consumption of bread, bakery goods, or milk from cows fed with flax flour; use of cough syrup or laxatives) or through contact with cattle feed or dog food, hair lotion, shampoo, depilatories, insulating materials, carpets, and some linen clothes.5Grant LR. A report of six cases of flaseed sensitization with review of the literature.J Allergy. 1931; 3: 469-477Abstract Full Text PDF Scopus (5) Google Scholar Our patient did not remember previous contact with linseed, although such contact may have occurred because of the numerous sources of exposure. A positive skin prick test result and specific IgE antibodies indicate a type I hypersensitivity. In our patient, the 22 kd protein seems to be the implicated allergen. In addition to psyllium,7Suhonen R Kantola F. Anaphylactic shock due to ingestion of psyllium laxative.Allergy. 1983; 38: 363-365Crossref PubMed Scopus (30) Google Scholar linseed should also be considered a possible cause of anaphylaxis from laxatives. We think new cases could arise because of the increasing use of products from health food shops. Flaxseed is also used in some multigrain breads and bakery products. We thank Ifidesa-Aristegui Laboratories for their collaboration in the realization of the in vitro study.