ARCHIVED - Tables - Garlic and Onions: Insufficient Evidence to Include on the List of Priority Food Allergens in Canada: A Systematic Review [Health Canada, 2009?]
| Author, Year, Country | Study Design Details | Subjects | Clinical History | Symptoms & Signs Footnote 1 (before challenge) | Symptoms & Signs Footnote 1 Severity of Rxn Footnote 2 after Challenge | Diagnostic Tests Footnote 3 | Eliciting Dose | Eliciting Allergen | Prevalence | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Garlic | ||||||||||
| Rancé and Dutau, 1997 France | Open study assessing over 25 allergens including garlic using SPT, prick + prick test IgE LFC and SBPCFC (when LFC negative) |
142 SUB (Ch) Age: 7m - 15y Sex: 95M: 47F |
Hx of food allergy | Multiple presenting symptoms in 66% Ch AD 61% |
Positive Rxn to garlic 1/142 in LFC | SPT, prick + prick test, IgE | 1 mg to 5 g for all allergens tested Further details were not provided |
Commercial extract and extract from fresh foods | 1/142 (1%) positive for garlic allergy LFC | No comments relevant to garlic |
| Rancé and Dutau, 2002 France | Open allergy study assessing foodstuff including garlic documented by DBPCFC in BA SUB identified by pulmonary function | 163 SUB (Ch) Age: 2 - 17 y Sex: 109M: 54F |
Family Hx atopy 91% Hx of ≥ 1 food allergies BA for Ave 5.5y |
SK 59% |
Asthma induced by food allergens potentially severe 6% of SUB reported A Rxn |
SPT |
Details not provided | Various food extracts Further details not provided |
Positive allergy to garlic 1% SUB | Prevalence of asthma induced by food allergens: 10% |
| Onion | ||||||||||
| Valdivieso et al., 1994 Spain | SPT for onion performed on 106 SUB randomly chosen from allergy clinic, Positive responders participated in one or more of the following: bronchial or nasal provocation, double-blind oral provocation, IgE (RAST) | 106 SUB randomly chosen from allergy clinic; 8 SUB positive SPT Rxn (8%) 4/8 SUB has clinical symptoms to onion exposure Age: 31-45 y Sex: 1M: 3F |
Hx of food and pollen allergies | Pollen or onion induced: |
2 SUB had intense RC and 1 SUB had chest tightness, wheezing and D after exposure to smell of onions Oral provocation in 2 SUB did not elicit a Rxn |
SPT 106 SUB Bronchial provocation 2 SUB Nasal Provocation 1 SUB Double-blind oral provocation 2 SUB |
SPT - 516µg protein/ml Bronchial & Nasal - 1:1 v/v onion extract Oral - 2 g onion powder |
Fresh onion, onion powder |
8 SUB (8%) positive SPT 3/8 SUB positive IgE onion 4/8 SUB Pollen-specific IgE 2/4 SUB garlic-specific IgE |
4 Sub had immediate positive SPT to fresh onion, garlic, fried onion and leek. All showed positive reaction to heated and non-heated onion extract Results suggest respiratory allergy |
| Garlic and Onion | ||||||||||
| Boccafogli et al., 1994 Italy | Open study assessing frequency of food-induced symptoms or allergy in SUB monosensitized to grass pollen SPT, MAST-CLA & oral challenge (0.45 mg food administered w/ 10-fold increase in 30 min intervals until cumulative dose of 5 g if no Rxn observed administration up to 50 g in 30 min intervals | 169 SUB monosensitize to grass pollen Age: 9 - 54 y Control 50 SUB monosensitize to Derma-tophagoides Age: 10 - 52 y |
Hx of BA and/or R during grass pollen season or household dust Positive SPT, MAST-CLA and nasal challenge for aero-allergens |
Pollen group had increased frequency of adverse food Rxn 81/169 (48%) compared to control 3/50 (6%) Symptoms: |
Garlic and onion mainly associated w/ U & GI symptoms 19/169 SUB (11%) considered to have food allergies 46/169 SUB (27%) considered to have food intolerance |
SPT MAST-CLA Oral challenge |
Details not provided |
Garlic & Onion No further information provided |
19/169 SUB (11%) considered to have food allergies 1/169 garlic (0.5%) 1/169 onion (0.5%) (IgE sensitized, OAS, GI and/or U/AE within 2 hours after ingestion of small quantity) |
Number of SUB with food intolerance higher than that of SUB w/ food allergy Cross reactivity between pollen allergens and food allergens may explain food allergy association but not higher incidence of food intolerance, increased intestinal permeability to macro-molecules hypothesised |
| Romano et al., 1995 & 1998 Italy | Retrospective Food-dependent EIA study in SUB with Hx of EIA within 2 hours after meal 26 food allergens tested by SPT, IgE assay 8/14 SUB participated in food-exercise challenge |
14 SUB w/ Hx of food-EIA Age: 16-27 y Sex: 10M: 4F |
Family Hx of allergy 50% Hx pollen allergy 29% |
Hx of A | 14/14 allergic to 2 or more food allergens 10/14 positive for onion and 9/14 positive for garlic by SPT/IgE specific levels 1 SUB participated in food-exercise challenge after consuming garlic - no Rxn observed |
SPT RAST (IgE) |
Not provided | Onion or garlic no further details provided | 10/14 (71%) positive for onion 9/14 (64%) positive for garlic No Rxn observed after garlic-exercise challenge; Onion not tested |
Hx data less helpful interpreting positive SPT/RAST for garlic, onion, parsley & basil because patients could not recall if they were part of the EIA - meal |
Asero et al., 2007 Italy |
Open allergy study assessing vegetable foods including garlic and onions to identify which vegetables are safe for lipid transfer protein-(LTP) allergic SUB to consume | 49 SUB (mono-sensitized to LTP) Age: mean 29 y Sex: 21M: 28F Controls: |
Hx of Rx to vegetables including garlic and onions | Hx of OAS No SUB reported Hx of allergy to garlic 2/49 (4%) reported Hx of allergy to onion |
8/36 (22%) SUB positive SPT to garlic 16/41 (39%) SUB positive SPT to onion 4/13 (31%) controls positive SPT to garlic 6/14 (43%) controls positive SPT to onion Results not considered statistically significant |
SPT | No provided | Commercial vegetable food extracts No further details provided |
8/36 (22%) SUB positive SPT to garlic 16/41 (39%) SUB positive SPT to onion 4/13 (31%) controls positive SPT to garlic 6/14 (43%) controls positive SPT to onion Results not considered statistically significant |
Specificity of SPT poor, many patients showed positive SPT to foods that they reported eating without any problems, including garlic and onions |
| Author, Year, Country | Study Design Details | Subjects | Clinical History | Symptoms & Signs Footnote 1 (before challenge) | Symptoms & Signs Footnote 1 Severity of Rxn Footnote 2 after Challenge | Diagnostic Tests Footnote 3 | Eliciting Dose | Eliciting Allergen | Prevalence | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Onion | ||||||||||
| Avila-Castanon et al., 2002 Mexico | Retrospective analysis of 1419 SUB w/ food allergies to determine frequency of hypersensitivity to foods | 1419 SUB (Ch) Age: 12m - 18 y Sex : details not provided |
Hx of food allergies | Most allergy affect age groups: 4-7y (49%) |
No applicable to study design | SPT | Details not provided | Onion Further details not provided |
4% SUB positive SPT to onion | Onion identified in group of foods responsible for 58% of allergic Rxn (fish, milk, seafood, soy, beans, orange, onion, tomato, chicken, nut, lettuce and strawberry) |
| Garlic and Onion | ||||||||||
| André et al., 1994 France | Retrospective analysis of 9 y period investigating foodstuff most frequently associated with A Rxn | 580 SUB 480 Ad Age: 1-83 y Sex: |
Hx of adverse Rxn to food | 60/580 (10%) SUB Hx sev Rxn to food A 52/60 (87%) |
Not applicable to study design | SPT |
Details not provided | Garlic & Onion | Garlic & Onion were not among the top 19 foods most frequently associated with A Rxn (celery 18% to camomile 1%) | Evolution of sensitization over 1984-1992 indicate an overall increasing trend for garlic and onions Increased consumption and more attentive clinical examinations are credited for this evolution |
Moneret-Vautrin et al., 2002 Country not cited |
Retrospective analysis of a food allergy database (589 SPT) 1 SUB (case 2) DBPCFC for garlic 1 SUB (case 3) SBPCFC for garlic 1 SUB (case 4) LFC for garlic |
Food allergy database 589 SUB: 402 Ch Age: < 15 y 187 Ad Age: not reported Sex: not reported |
Hx of food allergy | Case 1 w/ systemic mastocytosis & A induced by celery, carrot, onion, hazelnut Case 2 w/ U & AE Case 3 w/ R, BA, & U from fruits and vegetables Case 4 w/ U & A from garlic and onion soup |
Case 1: no challenge reported Case 2: U after 45 min SEV: mild Case 3: laryngeal pruitus, rhinorrhea, cough SEV: mild-mod Case 4: positive LFC result |
SPT, DBPCFC, SBPCFC, LFC | Case 2: 1000 mg garlic Case 3: 500 mg garlic |
No details provided about garlic used in challenge reports | 20/265 positive SPT for garlic (8%) 7/263 positive SPT for onion (3%) |
In this series, 2 spices responsible for half cases observed: garlic and fennel seed |
| Author, Year, Country | Cases | Clinical History | Symptoms & Signs Footnote 1 Severity of Rxn Footnote 2 |
Diagnostic Tests Footnote 3 | Eliciting Dose | Eliciting Allergen | Comments |
|---|---|---|---|---|---|---|---|
| Garlic | |||||||
| Burden et al., 1994 United Kingdom | 1 male Age: 58 y |
Sev SK Rxn on the hands after taking garlic extract | Double-blind oral provocation w/ garlic tablets once daily for a week result D of the hands; no Rxn to placebo SEV: mild |
Oral Challenge | Not provided | Garlic extract & garlic tablet | Lack of systemic Rxn reported when garlic is ingested by SUB w/ contact allergy may either be dose-related or due to the relevant antigens being heat-liable and destroyed by cooking |
| Asero et al., 1998 Italy | 1 female Age: 35 y |
Hx of systemic U/AE associated with both raw and cooked garlic |
U/AE but no GI symptoms reported after ingestion of garlic SEV: mild |
SPT | Not provided | commercial garlic extract & fresh garlic | In a series conducted by this author w/ over 300 SUB w/ both pollen allergy and OAS no SUB reported garlic intolerance, suggest lability of cross-reactive antigen No GI symptoms of this case suggest garlic allergens destroyed by enzymatic digestion |
Perez-Pimiento et al., 1999 Spain |
1 female Age : 23 y |
Hx of allergy to pollen and dried fruit and food-dependent EIA | An A Rxn after eating young garlic, emergency medical treatment was required SEV: sev |
SPT |
Not provided | Young garlic (unripe garlic) | SUB tolerated garlic cloves and other Liliaceae but was sensitized to pollen and foods distantly related to garlic No oral challenge (sev Rxn) |
| Pries et al., 2002 Portugal | 1 male Age: 16 m |
Hx of milk and egg white allergy Hx of tolerance of cooked garlic and onion |
Oral challenge with raw garlic positive generalized U SEV: mild Oral challenge with cooked garlic negative |
SPT |
Not reported | commercial garlic extract & fresh garlic | Suggest allergic fraction that this case is sensitized to is denatured by heat |
| Yin and Li, 2007 China | Case 1: 1 male Age: 42 y Case 2: 1 female Age: 16 y |
Both case had Hx of hay fever | Case 1: an A Rxn after eating young garlic (U, AE, throat swelling, D, syncope and hypertension) Case 2: an A Rxn while walking for 10 min after eating young garlic (EIA) |
SPT |
No reported | Young garlic | Limited detail provide in the abstract. Challenge study refused by subjects. |
| Onion | |||||||
| Hicks & Tanner, 1998 USA | 1 male Age: 27 y |
Hx of food-dependent EIA requiring emergency medical attention | EIA (lightheadedness, generalized pruritus, numbness in jaw, facial swelling) Played basketball after eating SEV: sev |
SPT positive for corn, soybeans, peanuts, walnuts, cabbage & onion Self-conducted oral challenge with chicken, peanut, potatoes & onion negative w/out exercise challenge |
Not provided | Several foods including onion | Challenge to cooked onion not performed |
Arena et al., 2000 Spain |
1 female Age: 44 y |
No Hx of allergies to areo-allergens or other foods | An A Rxn after eating raw/lightly-cooked onion SEV: sev |
Onion-specific IgE Positive for raw onion, negative for cooked onion |
Not provided | Raw onion | SUB sensitized to thermolabile antigenic fraction of onion. Cooked onion tolerated |
| Asero et al., 2001 Spain | 1 male Age: 45 y |
Hx of OAS and gastric pain after ingesting peaches | Sev systemic U/AE Rxn after eating raw onion SEV: mod Tolerate cooked onion |
SPT Onion-specific IgE Total IgE positive |
Not provided | Raw onion | No reaction to cooked onion |
| Perez-Calderon et al., 2002 Portugal | 1 female Age: 26 y |
Hx of RC & BA due to pollen allergies | Several episodes of A type Rxn after eating onion and exercising (EIA), at least one episode requiring emergency medical treatment SEV: sev |
SPT FC at rest negative FC w/ cooked onion positive after exercise 10 min, 2-hours after eating |
30 g cooked onion | Raw & Cooked onion | Observed cross-reactivity w/ other members of the Lilaceae family (garlic, asparagus or leek) |
| Enrique et al., 2007 Spain | 1 female Age: 19 y |
Hx of RC and U to mugwart and oral pruritus after eating raw onion and peach | U after eating raw onion SEV: mild |
SPT Onion-specific IgE positive |
Not provided | Raw onion | Cooked onion extract not tested |
| Garlic and Onion | |||||||
| Belleau and Blaiss, 2007 USA | 1 male Age: 5 y |
Hx of perennial allergic R, atopic dermatitis, mild intermittent asthma, egg and peanut allergy | An A Rxn requiring medical intervention after consuming steak seasoned with "Kraft Greek Vinaigrette Dressing" | SPT positive for peanuts, kraft dressing, whole egg, garlic RAST positive for garlic, onion and various foods |
Not provided | Garlic and onion in salad dressing | Challenge study considered inappropriate based on severity of Rxn. |
Abbreviations: Ad: adult; CH: challenge; Ch: children; DBPCFC: double-blind ,placebo-controlled food challenge; F: female; Hx: history; LFC: labial food challenge; M: male; max: maximum; min: minute; mod: moderate; Mus: mustard; OC: occupational; OFC: oral food challenge; Res: respiratory; Rxn: reaction; Sen: Sensitization; SEV: severity; sev: severe; SBPCFC: single-blind, placebo-controlled food challenge; SUB: subjects; w/: with; (y) years old
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