If you think you might have a cannabis allergy, what's your next step? What do you do? Where do you go? Well, it’s pretty simple. You book an appointment with an allergist, of course.
The evaluation of cannabis allergies is dependent largely on skin testing. A skin prick test can detect if a person is sensitive to a specific allergen. If sensitive, to protect the body from a perceived threat, the immune system produces a type of antibody called immunoglobulin E (IgE). An allergen-specific IgE blood test is done to check whether a person is allergic to a particular substance. Because IgE antibodies are unique to each allergen, checking for specific variants in the blood can help determine if an allergy is present. The tests are not invasive and tend to produce quick results.
A positive skin prick test to a particular allergen does not necessarily indicate that a person will experience a reaction caused by that allergen. Therefore, healthcare practitioners must compare the skin test results with the time and place of a person’s symptoms to see if they match. If the results of prick tests are negative, they may be followed by intradermal tests, which give allergists more details about what’s causing the underlying symptoms. After either test, the area of the skin is observed for about 15 minutes to see if a reaction develops. The “wheal” (an itchy, red bump) and “flare” (surrounding redness) indicate the presence of an allergy antibody. The larger the wheal and flare, the greater the sensitivity to the allergen.
Although skin testing may seem simple, it must be carried out by trained practitioners with an understanding of the variables and risks of the testing procedure. Extracts for testing are typically created with crushed buds, leaves, and flowers of the cannabis plant. Differences in source material and extraction techniques can introduce significant variability while contaminants and additives in the native allergen can cloud diagnostic evaluation. Consequently, without reliable standardized diagnostic testing options and often poor correlation between testing and true clinical allergy, the importance of patient history in making evaluations is paramount.
Is Treatment Available for Cannabis Allergies?
William Silvers, a Colorado allergist, published an editorial in February 2016 discussing three recent patients with symptoms suggestive of marijuana allergies. He provides a great insight into the practical experience of an allergist dealing with potential marijuana allergies in a state where cannabis has been wholly legalized.
One patient, a frequent marijuana smoker, experienced nasal congestion that later developed into a chronic cough once he began work as a trimmer at a marijuana growth facility. Treatment with a nasal spray and inhaler helped to reduce symptoms.
A second patient, without any prior history of asthma or allergies, demonstrated symptoms after exposure to marijuana when he began work in a grow facility and dispensary. He was diagnosed as having asthma exacerbated by marijuana exposure with hay fever, eye inflammation, and suspected contact dermatitis to marijuana. Treatment recommendations included minimizing his environmental exposure to marijuana as much as possible. The patient significantly improved with a prescribed medication program.
The final patient, a heavy marijuana consumer, was referred by an emergency department physician with suspected anaphylaxis after exposure to marijuana smoke. He admitted to smoking concentrate, a carbon dioxide extracted marijuana wax, that contained up to 60% to 70% THC levels. Puzzlingly, he showed a lack of sensitization to marijuana extracts and pollen tests were negative. The wax concentrate might have contained a contaminant or additive to which the patient reacted.
Despite the low, mumbled presentiments of an epidemic, in Dr. Silvers’ opinion:
…the relatively low numbers of “presentations since legalization of marijuana in Colorado suggests that cannabis sativa is a mild allergen, with significant exposure required to elicit respiratory and dermatologic allergic reactions.”
This sounds like good news for cannabis lovers and, as demonstrated, treatment is available for allergy sufferers depending on the seriousness of the reaction. Unfortunately for the chronically-allergic cannabis consumer, as with other allergens, avoidance is recommended.
Still, factors such as local aerobiology and occupational exposures need to be taken into consideration. Antihistamines, intranasal steroids, and nasal decongestants can be used to treat symptoms of allergic rhino conjunctivitis. Asthma can be treated with Beta agonists or an inhaled corticosteroid if required. EpiPens should be prescribed for patients with a history of anaphylaxis.
There have even been rare cases of treatment with immunotherapy in the literature. One report demonstrated desensitization in two patients and improvement was noted in a cohort of hemp workers who received immunotherapy extract twice a week for a year. For those experiencing symptoms, we’re not claiming that a cannabis-allergy Kryptonite has been discovered, but there are certainly a variety of options out there.
Although still relatively uncommon, allergies associated with cannabis are being reported with increased frequency. Allergic reactions as severe as anaphylaxis attributed to cannabis have been noted with sensitization associated with pollinosis, cannabis consumption, occupational exposure, and potential plant cross-reactivity. However, there is no reason to panic. It’s to be expected that the reporting of cannabis allergies would increase as cannabis consumption became more mainstream.
Cannabis allergies can be treated in much the same way as other allergies but the lack of standardization in testing limits validation and the widespread applicability of diagnostic testing. Much research is still needed to more accurately define allergens, develop a standardized extract, establish diagnostic specificity, and clarify treatment options for patients.
Without a shadow of a doubt, the legal limitations to obtaining cannabis extracts poses challenges as the only federally approved source of cannabis species in the United States is located at the University of Mississippi, while the illicit nature of cannabis consumption is still creating obstacles for patient reporting. If we’re to learn more about cannabis allergies, we need to overcome the former by enabling more wide-ranging research, while eliminating the latter by encouraging silent cannabis allergy sufferers to breach the surface of public opinion and engaging them in a non-judgmental way.
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