One of the most common ailments out there for any individual to have is an allergy. Be it to animal dander, a certain food type, or plant pollen, allergies can cause mild symptoms like sneezing, itchy eyes, or a rash, up to life-threatening symptoms like a fever or anaphylaxis depending on the severity. Needless to say, before one lights up some cannabis for the first time, they should make every effort to find out if they are allergic beforehand.
Being a plant, cannabis contains pollen, which is a major allergen – the cause of allergies. Though considered relatively rare by most who study the topic, cannabis allergies do in fact exist because of pollen, and can cause many of the same symptoms of allergic sensitization like sneezing, itchy eyes, etc. in patients.
In fact, the American Academy of Allergy, Asthma, and Immunology has an official entry for cannabis allergy here: https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/marijuana-cannabis-allergy. Referred to as the “marijuana cannabis allergy,” Dr. Andrew Moore, a Fellow of the American Academy of Allergy Asthma and Immunology (FAAAAI) refers to the manifestation of symptoms in the article as quite similar to most other plant allergies:
“The symptoms of marijuana allergy include many clinical manifestations depending on how a person was exposed. Contact or touching the plant can result in breaking out in rashes, hives, or swellings called angioedema. Breathing or inhaling marijuana allergens can result in nasal or ocular or eye allergy symptoms. This includes runny nose, sneezing, itching, and swelling and watering eyes. Asthma with the development of wheezing and shortness of breath also can occur. Anaphylaxis has also been reported. This most commonly occurs with hempseed ingestion.”
From this information, one can begin to understand the two types of allergen contact: skin and inhalation/ingestion and their varying levels of impact. Skin contact with a cannabis plant in sensitive or allergic individuals results in the hallmark allergy symptom of angioedema, a clear and visible sign of the allergy presenting itself through red marks or hives on the body. Ingestion symptoms, like coughing or red eyes, might be harder to identify given the association to symptoms already present when smoking.
When comparing the severity of allergic reactions between skin contact and ingestion, a bad hives reaction from skin contact may seem bad, but ultimately mild when compared to full-on anaphylactic shock from accidental ingestion. Anaphylaxis, however, is very rare and is more often found in individuals allergic to hemp seeds – seeds are another major allergen that happen to be found in cannabis, and seed allergies are quite nasty in general compared to other kinds. The range of symptoms with ingestion, however, is further complicated by other factors too, like the ever-evolving world of edibles.
“In addition, there is reported cross-reactivity between marijuana and certain foods,” Moore goes on to say. “Cannabis cross-reacting foods that have been reported to cause allergy include tomato, peach and hazelnut. This is due to cross-reacting proteins or allergens found both in marijuana and these foods. This cross-reactivity can potentially cause serious allergic reactions. The important and relevant allergens still require research and clinical definition.”
While this claim does not directly say edibles may be more dangerous, they may in fact be on the condition that the patient or consumer is unaware of both compounding allergies. However, knowing is half the battle, and while Moore goes on to say that a standardized test is not yet developed, the dreaded “prick” test at one’s local doctor’s allergen panel might be the best option for cannabis allergy testing going forward.
“There is no standard way to test for marijuana allergy, at present, and a careful history is typically used,” Moore notes. “Skin testing could be considered for patients who have histories of cannabis allergic reactions. The allergist can prepare an extract or slurry using the buds, leaves and flowers of the marijuana plant. A standard prick skin test, similar to that which is done in any standard allergy testing can then be done. While these tests are not standardized, they can be used generally to predict allergic sensitization.”
The final points of the entry by Moore speak about the upward trend of cannabis allergies as cannabis becomes more popular, a simple economic fact that cannot be avoided, but that severity is usually limited like with most severe allergens.
“With the increased use of cannabis or marijuana by industry, medicine, and the general population as well as legalization there will be more reports of allergy,” Moore concludes. “The symptoms although usually benign include nasal, ocular and pulmonary complaints. However life-threatening reactions have occurred but are generally limited to hempseed in marijuana allergic individuals.”
This same predictive notion was one of the points driving home in the recent scientific article, “An emerging allergen: Cannabis sativa allergy in a climate of recent legalization,” out of the Allergy, Asthma & Clinical Immunology (AACI) journal, the official publication of the Canadian Society of Allergy and Clinical Immunology (CSACI).
“Cannabis sativa allergy is expected to increase as a consequence of legalization due to increased exposure. Additionally, as legal and stigma-related barriers to use subside, an unintentional side effect of legalization may be increased reporting of current suspected cases of Cannabis allergy.” (Jackson et al).
As the trio of authors observe, more instances of cannabis allergies may be unavoidable as the sheer numbers grow, but knowledge about those instances makes the severity lessened considerably. Another important factor to also consider in the article is that Canada has had cannabis fully legalized for longer than the United States, therefore allowing them more time to observe the range of effects from legalization, as the authors go on to conclude.
“The only proven, currently available treatment for Cannabis allergy is avoidance. However, when avoidance is impossible, treatment of C. sativa allergy is identical to that of other allergens: based on the index reaction to the substance. Treatment with antihistamines, intranasal corticosteroid sprays, and ophthalmic antihistamine drops can provide symptom relief. All individuals with anaphylactic allergies should carry auto-injectable epinephrine. Treatment for Cannabis-fruit-vegetable syndrome is also dependent on avoidance.” (Jackson et al).
For years, cannabis allergies were not as prevalent in medicine, and many patients may have not even realized cannabis contains allergens. With the influx of study on the matter today, safety and information on the topic is plentiful and, like most things in life, knowing is half the battle when determining if one has the rare affliction of the cannabis allergy.
Jackson, B., Cleto, E. & Jeimy, S. An emerging allergen: Cannabis sativa allergy in a climate of recent legalization. Allergy Asthma Clin Immunol 16, 53 (2020). https://doi.org/10.1186/s13223-020-00447-9
Moore, Andrew. “Marijuana Cannabis Allergy.” American Academy of Allergy Asthma & Immunology, 9 Aug. 2020, https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/marijuana-cannabis-allergy.
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