Selective cannabis strain allergy in a patient presenting with a local allergic reaction

Abstract

Background Cannabis use is growing domestically due to recent legalization in many jurisdictions. There are two main species of cannabis, Cannabis sativa and Cannabis indica, and thousands of different commercially available cannabis strains. Although there are multiple reports of cannabis allergy in the literature, to our knowledge, there is no prior published report of selective cannabis strain allergy. Case presentation A 31-year-old male was referred for allergy assessment due to several episodes of localized pruritus and erythema after direct contact with various strains of cannabis. He had noted that the severity of his reaction appeared to be strain dependent. He developed a severe local reaction involving bilateral periorbital edema shortly after coming into direct contact with one particular strain of cannabis. He denied any adverse symptoms after inhalation of cannabis. Fresh skin prick testing was performed to various strains of cannabis and had positive testing to the three of the five tested strains. Conclusions We believe this is the first reported case of selective cannabis strain allergy based on patient history and skin prick testing. This case report outlines the variability in different strains of cannabis and stresses the importance of further research into cannabis allergen identification. Multiple cannabis allergens should be included and incorporated into commercial extracts when they become routinely available.

IgE-Mediated Allergy and Asymptomatic Sensitization to Cannabis Allergens—Review of Current Knowledge and Presentation of Six Cases

“…Both patients had a positive skin prick test (SPT) result to protein extract from C. sativa buds and Pru p 3. Stepaniuk and Kanani presented a case of selective cannabis strain allergy [ 26 ]. Another patient suffering from second-hand CA is a 6-year-old boy associated with chronic worsening of asthma [ 27 ].…”

Cannabis‐related allergies: An international overview and consensus recommendations

“…There are no commercially available extracts, so unstandardized prick–prick tests (PPT) with the buds, leaves, or seeds of the cannabis plant is usually the only option, if available 63,118 . If possible, several different strains of the cannabis plant (sativa, indica and hybrid) should be used to ensure a wide variety of potential allergens are included 108 . Unfortunately, those sensitized to pollens or plant foods can have clinically insignificant positive results, due to ubiquitous plant proteins such as profilins, decreasing the specificity of the cannabis PPT test.…”

“…13 Detailed studies into occupational cohorts are needed, including whether specific strains are more likely to provoke allergic reactions or if those with a previous allergic history have a higher rate of cannabis allergy. 108…”

“…For example, Can s 3, a mediator of cross‐reactive allergies related to cannabis, has not been established as a relevant allergen in the context of occupational exposures 13 . Detailed studies into occupational cohorts are needed, including whether specific strains are more likely to provoke allergic reactions or if those with a previous allergic history have a higher rate of cannabis allergy 108 …”

“…63,118 If possible, several different strains of the cannabis plant (sativa, indica and hybrid) should be used to ensure a wide variety of potential allergens are included. 108 Unfortunately, those sensitized to pollens or plant foods can have clinically insignificant positive results, due to ubiquitous plant proteins such as profilins, decreasing the specificity of the cannabis PPT test. An alternative option is to perform SPTs with preprepared cannabis extracts, which can be better standardized, and designed to concentrate known allergen components such as Can s 3.…”