Ginger

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Code: f270
Latin name: Zingiber officinale
Family: Zingiberaceae
Common names: Ginger, Ginger root, Green (Fresh) Ginger
Spice
A spice, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Geographical distribution
These pungent rhizomes of the Zingiberaceae family of herbaceaous pennenials probably originate in southern China but are now cultivated all over southern Asia (50% of all Ginger is produced in India), in Latin America and in Africa. Ginger is one of the world’s most important spices; it was already a "staple" in China from ancient times and was used in the pre-Christian West.
 
The common cooking Ginger is a herbaceous perennial creeping plant, with thick tuberous rhizome, producing an erect stem about 1.5 m tall and narrow medium green leaves arranged in two ranks on each stem. The lance-shaped leaves are bright green, 15-20 cm long and 2 cm wide, with a prominent longitudinal rib. The inflorescence grows on a separate stem from the foliage stem, and forms a dense spike, up to 7.6 cm tall. The bracts are green with translucent margins and the small flowers are yellow green with purple lips and cream-colored blotches. Most Gingers in cultivation are sterile cultivars grown for the edible rhizome, and the flower is rarely seen.
 
In the fresh state, Ginger has a staghorn-like appearance; dried Ginger is usually sold in the form of a tannish powder, and there are also preserved forms. Dried roots are sold either “black”, with the root skin left on, or "white", with the skin peeled off. A great variety of cultivars from different locales have different flavours and uses. The essential oil (mainly sesquiterpenes) makes up 1 to 3% of the fresh rhizome.
 
Environment
In Western countries, Ginger is widely used for culinary purposes in Gingerbread, biscuits, cakes, puddings, soups and pickles. It is also used in the production of Ginger “beer” and Ginger "ale". Ginger ale is a soft drink that enjoys considerable popularity in the USA. Like root beer, it is not a fermented beer, but simply sugar, plant extract and carbonated water. Ginger is one of the most widely used spices in Oriental cookery, either on its own or as a flavouring (the leaf may occasionally be used). It is a frequent constituent of curry powder. Bottled and crystallised Ginger are popular in the East. Pickled Ginger, accompanying sushi, has the root sliced paper-thin and pickled in a vinegar solution.
 
The rhizomes yield a pale-yellow essential oil by steam distillation, which lacks the pungent principle. It finds limited use as a flavouring essence and in perfumery, but has been increasingly used in men's toiletries. An oleoresin is obtained by solvent extraction from ground Ginger in which the full pungency of the spice is preserved; it is used for flavouring purposes, particularly for soft drinks and in medicine. The volatile oil and oleoresin are used as additives in commercial products, including mouthwashes, medicine and insect repellent (1).
 
Traditional therapeutic uses of Ginger include the treatment of gastrointestinal symptoms and as a counter-irritant and an aphrodisiac. The efficacy of Ginger has been documented for rheumatism and musculoskeletal disorders. More than three-quarters of a group of arthritis patients experienced, to varying degrees, relief of pain and swelling following treatment with Ginger. The mechanism may be dual inhibition of eicosanoid biosynthesis (2). Oral Ginger improves gastroduodenal motility in the fasting state and after a standard test meal (3). 
 
Unexpected exposure
See under Environment.
 
Allergens
No allergens from this plant have yet been characterised.

Potential Cross-Reactivity

An extensive cross-reactivity among the different individual species of the genus could be expected (4).

Clinical Experience

IgE-mediated reactions
Ginger may uncommonly induce symptoms of food allergy in sensitised individuals. Symptoms include dermatitis, contact dermatitis, eczema, and pompholyx eczema.
 
The French CICBAA data bank includes 589 cases of food allergies, and includes data on allergies to spices. Frequent sensitisation to Apiaceae has been observed. Coriander, Caraway, Fennel or Celery sensitivity manifested in 32% of skin prick tests in children, and in 23% in adults. Sensitisation to Liliaceae has also been observed. Garlic, Onion or chive sensitivity was observed in 4.6% of skin prick tests in children, and in 7.7% in adults. No positive skin-specific IgE test occurred for Nutmeg, Ginger and Clove (5).
 
Skin-specific IgE tests with powdered commercial spices performed in 70 patients with positive skin-specific IgE test for Birch and/or Mugwort pollens and Celery yielded a report of positive tests in more than 24 patients for Anise, Fennel, Coriander or cumin—all from the same botanical family (Apiaceae) as Celery. Spices from unrelated families (Red Pepper, White Pepper, Ginger, Nutmeg, Cinnamon) elicited positive immediate skin test reactions in only 3 of 11 patients (6).
 
Allergic reactions have been reported to inhalation of Ginger dust (7).
 
Although tests for Ginger allergy have predominantly been for immediate hypersensitivity reactions, a greater prevalence of Ginger allergy is recorded using tests for delayed allergy reactions. Of 55 patients with suspected contact dermatitis, patch test results (positive at concentrations of 10% and 25%) were most common with Ginger (7), Nutmeg (5), and Oregano (4); the remaining spices produced 0 or 1 positive responses (8).
 
Occupational allergy to Ginger may also occur. Occupational allergy occurred in a Gingerbread worker (9). Of about 1,000 patients investigated for occupational skin disease, 5 had occupational allergic contact dermatitis from spices. All patients had hand (or finger) dermatitis. The causative spices were Garlic, Cinnamon, Ginger, Allspice and Clove (10).
 
Other reactions
Anecdotally, excess Ginger ingestion has been said to cause irritation of the urethra.
 
As with a number of other common herbal remedies, such as Feverfew, Garlic, Ginkgo, and Asian ginseng, Ginger may increase the risk of bleeding during surgical procedures or potentiate the effects of warfarin therapy (11-13).
 
However, a study concluded that the effect of Ginger on thromboxane synthetase activity is dose-dependent, or only occurs with fresh Ginger, and that up to 2 g of dried Ginger is unlikely to cause platelet dysfunction when used therapeutically (14).
 
Compiled by Dr Harris Steinman, harris@zingsolutions.com

References

  1. Govindarajan VS. Ginger--chemistry, technology, and quality evaluation: part 1. Crit Rev Food Sci Nutr 1982;17(1):1-96
  2. Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypotheses. 1992;39(4):342-8
  3. Micklefield GH, Redeker Y, Meister V, Jung O, Greving I, May B. Effects of ginger on gastroduodenal motility. Int J Clin Pharmacol Ther. 1999;37(7):341-6
  4. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09
  5. Moneret-Vautrin DA, Morisset M, Lemerdy P, Croizier A, Kanny G. Food allergy and IgE sensitization caused by spices: CICBAA data (based on 589 cases of food allergy). Allerg Immunol (Paris) 2002;34(4):135-40
  6. Stäger J, Wüthrich B, Johansson SGO. Spice allergy in celery-sensitive patients. Allergy 1991;46:475-478
  7. van Toorenenbergen AW, Dieges PH. Immunoglobulin E antibodies against coriander and other spices. J Allergy Clin Immunol 1985;76(3):477-81
  8. Futrell JM, Rietschel RL. Spice allergy evaluated by results of patch tests. Cutis 1993;52(5):288-290
  9. Vetter E, Berger E, Freislebe R, Pokieser L. Kremser  M. Berufliche Inhalationsexposition mit Gewiirzen. Allergologie 1988;5:165-168
  10. Kanerva L, Estlander T, Jolanki R. Occupational allergic contact dermatitis from spices. Contact Dermatitis 1996;35(3):157-62
  11. Pribitkin ED, Boger G. Herbal therapy: what every facial plastic surgeon must know. Arch Facial Plast Surg 2001;3(2):127-32
  12. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57(13):1221-7
  13. Fessenden JM, Wittenborn W, Clarke L. Gingko biloba: a case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy. Am Surg 2001;67(1):33-5
  14. Lumb AB. Effect of dried ginger on human platelet function. Thromb Haemost 1994;71(1):110-1

 

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.