Clinical Experience
IgE-mediated reactions
Sweet Pepper or spices made from Sweet Pepper may induce symptoms of food allergy, rhinitis and contact dermatitis in sensitised individuals (6, 18-22). Urticaria as a result of contact with Paprika has been documented (23). Specific IgE antibodies to Sweet Pepper have been measured by Phadebas RAST (24).
A 27-year-old individual who developed rhinitis and asthma symptoms when preparing a spiced sausage was reported. Skin-specific IgE was detected to Paprika, Coriander, and Mace but not to other ingredients of sausage. Serum-specific IgE to Paprika, Coriander, and Mace were demonstrated. Specific bronchial inhalation challenges showed an immediate asthmatic reaction to extracts from Paprika, Coriander, and Mace, with a maximum fall in FEV1 of 26%, 40%, and 31%, respectively, and with no late asthmatic reactions (17).
The complexity of the relationship of allergens, the degree of individual variability, and the severity of the reactions are illustrated by a spice-and-condiment seller who experienced occupational-related anaphylaxis and concurrent rhinoconjunctivits caused by intake of Sweet Pepper. The patient tolerated other Solanaceae products, and attempts to inhibit IgE binding to Capsicum by other Solanaceae members failed (25).
In a study reporting on 7 cases of food-dependant exercise-induced anaphylaxis, the responsible foods were Wheat (2 cases), Maize, Barley, Shrimp, Apple, Paprika and Mustard (26).
Various components of Sweet Pepper may result in occupational disease (27).
Among 472 Sweet Pepper greenhouse employees, work-related symptoms were reported in 53.8%. Sensitisation to the Sweet Pepper plant was found in 35.4%. Positive reactions to leaf, stem and/or juice, however, were associated in nearly 90% with sensitisation to pollen, which appeared to be the most important allergen of the plant. Symptoms at work were found to be associated with an IgE-mediated allergy due to the high and chronic exposure to Sweet Pepper pollen (28).
Contact dermatitis, contact allergy and protein contact dermatitis have been frequently reported (29-31). A group of 103 patients with suspected contact allergy to spices was tested with the European standard series. Among the spices, the highest numbers of reactions were found to Nutmeg (28%), Paprika (19%) and Cloves (12%) (30). This study suggested that IgE-mediated immediate-type responses are directed against different antigens from those eliciting delayed responses.
Occupational contact urticaria from Paprika may also occur (32), and protein contact dermatitis from Paprika and curry has been reported in a cook with no history of atopy. He was found to have elevated total IgE and a high level of specific IgE to Sweet Pepper as tested by the Pharmacia CAP System. The results correlated well with a skin prick test (31).
Other reactions
Pungent-fruited Peppers may cause painful irritation when used in excess, or after accidental contact with the eyes. Pepper spray containing oleoresin capsicum is used by law enforcement and the public as a form of nonlethal deterrent but may result in corneal abrasions if in contact with the eyes (33). The sap of the plant can cause the skin to blister.
Erythema multiforme-like contact dermatitis has been reported (34).
Protection against thrips, a common pest in Sweet Pepper horticulture, is effectively possible without pesticides through use of the commercially available predatory mite Amblyzeius cucumeris. This mite is a new occupational allergen in horticulture, which may result in IgE-mediated allergy in exposed employees. In a group of Sweet Pepper horticultural workers, work-related symptoms were reported by 76.1%. Skin-specific IgE to this mite was found in 23% (109) of this group. Sensitisation to Tyrophagus putrescentiae was found in 62 employees, of whom 48 were also sensitised to A. cucumeris (35).
Serum-specific IgE against Paprika pollen, but not against Tomato pollen, was found in serum from 2 greenhouse workers who worked with Paprika plants. A greenhouse worker who cultivated Tomato plants had IgE against both Tomato and Paprika pollen. The authors conclude that the presence of IgE against Paprika or Tomato pollen is not restricted to workers in horticulture; IgE against these pollens can also be present in food-allergic patients who have serum IgE against Paprika and/or Tomato fruit (36).