Clinical Experience
IgE-mediated reactions
Hops may uncommonly induce symptoms of food allergy in non-occupationally sensitised individuals. Occupational allergy may commonly be associated with exposure to Hops. (6) Hops are an uncommon cause of occupational asthma and anaphylaxis. (7) Hops have usually been picked by hand. (However, more recently, picking machines have been introduced in some countries.) Skin contact with the plant causes dermatitis in susceptible people.
Systemic and contact urticaria have been documented. Contact urticaria from dried Hops occurred in a patient who had experienced urticaria and angioedema from Peanut, Chestnut and Banana. (7) A patient who presented 4 times with systemic urticaria associated with arthralgia and fever has been reported; investigation confirmed allergy to Hops. The authors suggest that in some instances the adverse effects of Hops are not due to allergy but to another mechanism that is unclear - the constituent lupuline may play a role. (8)
Hops dermatitis has long been recognised. It is a mechanical dermatitis attributed to the rough hairs on the stem and secretions of the yellow glandular hairs. (7, 9) Hop pickers can also develop a dermatitis from the leaves, as well as conjunctivitis and tenosynovitis, which is thought to be irritant rather than allergic, and due to the myrcene oxidation products humulone and lupulone. (1) Of 156 Ukrainian Hop workers, 15% were found to have Hop-related skin diseases. (10) Among 14 Polish farmers complaining of work-related skin symptoms, these were caused most often by Hops (11%), followed by grain (5.6%), hay (5.5%) and straw (4.1%). Five farmers (6.8%) complained of hand dermatitis, 4 (5.5%) of airborne dermatitis, and 8 (11.0%) of pruritus. On skin prick tests, 5.5% of farmers reacted to grain dust, 5.5% to straw dust, 11% to hay dust, and 8.2% to Hops. (11) Not only the hands and face but the legs may be involved due to Hop picking. Dislodged hairs from the plant can irritate the eyes.
In 73 eastern-Polish Hop farmers, 8 (11%) complained of skin symptoms provoked by contact with Hop. Four of them suffered from airborne dermatitis, 2 had hand eczema, and the remaining 2 complained of intense pruritus of uncovered skin when working with Hop. Two of the 8 farmers had had positive prick tests with Hop extracts. (12 , 13)
The onset of occupational airborne dermatitis and hand dermatitis to Hops in a 57-years-old female farmer has been documented. The disease appeared at the age of 46, 30 years into working with Hops without any health problems. The patient had erythema of the face, neck and upper chest, oedema of the eyelids, and conjunctivitis, as well as acute dermatitis of the hands. Both fresh and dried Hops precipitated the symptoms. Onset occurred after half an hour of working and persisted over 1-2 days. Despite discontinuing work, the patient experienced several relapses of her dermatitis, and this was attributed to her use of a beauty cream and a herbal sedative, which both contained Hops extract. Sleeping in a bed with her husband, who worked with Hops, provoked relapses of the patient's dermatitis. (The husband sometimes felt too tired to wash thoroughly after working on the plantation.) (13)
Anaphylaxis following exposure to Hops has been reported, and should be considered in individuals with “idiopathic” anaphylaxis. (14)
Occupational allergy to Hops has been reported. A chemist developed urticaria, rhinitis, conjunctivitis and asthma after 6 months’ work as a Hop selector for a brewery, (6) and a Hop farmer had occupational respiratory disorder. (15) A laboratory worker was also described who developed conjunctivitis, rhinitis, bronchitis and dermatitis to Hops. (16)
Other reactions
Hop leaves contain lupin and rutin. Sometimes Hops are treated with sulphur dioxide to improve the colour and prevent change of active substances.
Hops contain a phytooestrogen. This substance can also be detected in beer, but the levels are low and should not cause concern. (17) In animal studies, approximately 500-fold greater levels were required for oestrogenic effects than can be found in any beer. (18) The presence of 8-prenylnaringenin in Hops may provide an explanation for the accounts of menstrual disturbances in female Hops workers.
Of 23 Hops farmers exposed to organic dust from Hops, 5 (21.7%) reported work-related symptoms, including dry cough and dyspnoea. Eight farmers (34.8%) reported symptoms of chronic bronchitis. Spirometric values were within normal ranges. Precipitin tests and tests for inhibition of leukocyte migration to antigens of environmental microbes, mainly to the antigen of the Gram-negative bacterium Pantoea agglomerans, were positive. (19)