Parsley

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Code: f86
Latin name: Petroselinum crispum
Source material: Fresh leaves
Family: Apiaceae (Umbelliferae)
Food
A food, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Geographical distribution
Parsley has been in human use in the Mediterranean since around 2,000 years ago. This bright green annual herb is now cultivated almost throughout the world. Both roots and leaves can be used. Oil, obtained by steam distillation of ripe seeds of the herb, may be employed for flavouring.
 
Environment
Parsley serves as an herb, especially in soups and stews, but is probably most familiar as a garnish. Because of its high chlorophyll content, Parsley makes an excellent breath freshener.
 
Oleoresin (a yellow to light brown substance with a harsh odour), an extract of Parsley, may be used to generate spice flavours in condiments. It is also a preservative and/or perfume for cosmetics.
 
Unexpected exposure
See under Other reactions.
 
Allergens
No allergens from this plant have yet been characterised.
 
The presence of an allergen related to Bet v 1, the major Birch pollen allergen, was shown in Parsley, but no allergenic characteristics were reported (1). 
 
Other studies have also suggested the presence of a Bet v 1-like allergen in Parsley, but with the implication that this may be an important Parsley allergen. A cloned Cherry allergen, with a 59.1% identity to Bet v 1, was shown to have a 40 to 60% similarity to related allergens from other kinds of tree pollen and plant foods, as well as to stress-induced proteins from food plants such as Parsley, Potato and Soya (2). Similarly, a protein isolated from Ginseng, with high homology to a pathogenesis-related protein of Parsley and to Bet v 1, was isolated (3). The Api g 1 allergen from Celery has a 40% identity (60% similarity) to Bet v 1. Api g 1 was shown to exhibit similar characteristics to 2 proteins in Parsley induced by fungal infection (4).
 
A class II chitinase has been isolated from Parsley. Not all chitinase-family proteins are allergenic, and whether this chitinase has any allergenicity or homology with allergenic chitinases was not evaluated (5).

Potential Cross-Reactivity

An extensive but variable degree of cross-reactivity among the different individual species of the Apiaceae could be expected (6).
 
Although a Bet v 1-like allergen has not been isolated from Parsley to date, cross-reactivity studies have by implication suggested the presence of this allergen, and therefore suggest cross-reactivity among plants containing this panallergen (2-4).   
 
The Bet v 1 panallergen may therefore be the allergen responsible for cross-reactivity reported in an individual with allergy to Celery resulting in urticaria, oedema, and anaphylaxis, who displayed sensitivity to Parsley, Carrot and Ragweed (7). Similarly, allergy to Celery associated with pollen allergy (Birch tree pollen in Sweden, Ragweed pollen in France, and Mugwort and Compositae in general) has been associated with cross-reactivity to other Apiaceae family members such as Parsley and Carrot (8).
 
In the so-called "Celery-Mugwort-spice syndrome", allergy to spices of the Apiaceae family is frequently associated with other allergies. The prevalence of clinical allergy among members of this food family was reported as the following: to Carrot in 52% of individuals, to Caraway in 26%, to Parsley in 16%, to Fennel in 13%, to Green pepper in 10%, and to Aniseed in 3% (9).

Clinical Experience

IgE-mediated reactions
Parsley may commonly induce symptoms of food allergy in sensitised individuals, in particular in individuals with allergic rhinitis from a pollen allergy (8, 10).
 
Symptoms include nasal and eye itchiness, laryngeal oedema, wheezing and common symptoms of food allergy.
 
Anaphylaxis and severe attacks of angioedema and urticaria have been reported (11-12). In 15 patients with severe attacks of angioedema and urticaria, in whom Celery and Parsley were confirmed as etiological agents, without exception all had positive skin IgE to Mugwort (12). 
 
Contact dermatitis from Parsley has been reported (13-14). Occupational dermatitis in gardeners following exposure to Parsley has also been described (15). Although contact dermatitis may be allergy-mediated,  phytodermatitis may indicate a non-IgE mediated reaction to a furanocoumarin compound in Parsley (16). (See below.)
 
Other reactions
Plants belonging to the Apiaceae accumulate methoxylated psoralens, such as bergapten or xanthotoxin, as the final products of their furanocoumarin biosynthesis. (The rate of accumulation depends on environmental and other cues.) (17). These substances may result in a phototoxic skin reaction, phytophotodermatitis or photodermatitis. Culprit plants other than Parsley include Celery, Limes, Parsley, Figs, and Carrots. The condition may be an occupational hazard (18).
 
Parsley is known to respond to pathogen attack by the synthesis of furanocoumarins, and to UV irradiation by the synthesis of flavone glycosides, whereas ozone treatment results in the induction of both pathways (19). Following sun exposure in an individual who has been exposed to Parsley, phytophotodermatitis can occur. Reactions may be so severe to have the appearance of partial skin thickness burns, as reported in 4 patients; 1 reaction occurred after contact with Parsley, and 3 others after contact with Giant Hogweed (20). Giant Hogweed (Heracleum mantegazzianum) and Parsley are members of the Apiaceae, indicating that other members as well may in certain instances produce similar adverse reactions.
 
Berloque dermatitis is a variant of phytophotodermatitis and is caused by high concentrations of psoralen-containing fragrances, most commonly oil of bergamot. Berloque dermatitis is not often seen because of the removal of these fragrances from most cosmetic products. In a study, a group of patients still at risk for berloque dermatitis was reported on. These patients use the colognes "Florida Water" and "Kananga Water," which are popular in Hispanic, African American, and Caribbean populations. These fragrant waters are used for spiritual blessing, treating headaches, and personal hygiene (21).
 
Parsley in an herbal product was reported to potentially increase the risk of bleeding or potentiate the effects of warfarin therapy (22). Parsley has also been reported to have diuretic actions (23-24).
 
The ingestion of Parsley has been often used to induce abortions, and if it is used in conjunction with fringed rue (Egyptian rue, ruda) (Ruta chalepensis/graveolens), severe adverse reactions may occur (25).
 
Parsley has also been associated with the outbreak of food poisoning episodes.
 
During 1998, 8 restaurant-associated outbreaks of shigellosis occurred in the United States and Canada. The illness was comprehensively associated with the ingestion of Parsley at 4 restaurants; at the other 4 restaurants, the majority of the people who contracted the illness had eaten Parsley. Parsley has also been implicated in Escherichia coli outbreaks in Minnesota (26).

Compiled by Dr Harris Steinman, harris@zingsolutions.com

References

  1. Carpin S, Hamdi S, Rideau M. Characterization of a protein related to Bet v 1, the major birch pollen antigen, from cells of the Madagascar periwinkle. Universal presence of proteins of this type among higher plants. [French] Allerg Immunol (Paris) 1997;29(8):242-3
  2. Scheurer S, Metzner K, Haustein D, Vieths S. Molecular cloning, expression and characterization of Pru a 1, the major cherry allergen. Mol Immunol. 1997;34(8-9):619-29
  3. Bufe A, Spangfort MD, Kahlert H, Schlaak M, Becker WM. The major birch pollen allergen, Bet v 1, shows ribonuclease activity. Planta 1996;199(3):413-5
  4. Breiteneder H, Hoffmann-Sommergruber K, O'Riordain G, Susani M, et al. Molecular characterization of Api g 1, the major allergen of celery (Apium graveolens), and its immunological and structural relationships to a group of 17-kDa tree pollen allergens. Eur J Biochem 1995;233(2):484-9
  5. Ponath Y, Vollberg H, Hahlbrock K, Kombrink E. Two differentially regulated class II chitinases from parsley. Biol Chem 2000;381(8):667-78
  6. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09
  7. Bonnin JP, Grezard P, Colin L, Perrot H. A very significant case of allergy to celery cross-reacting with ragweed. [French] Allergie et Immunologie 1995;27(3):91-3
  8. Dechamp C, Deviller P Rules concerning allergy to celery (and other Umbellifera). [French] Allerg Immunol (Paris) 1987;19(3):112-4, 116
  9. Wüthrich B, Hofer T. Food allergy: the celery-mugwort-spice syndrome. Association with mango allergy? [German] Dtsch Med Wochenschr 1984;109(25):981-6
  10. Vallet G. Allergy to market garden plants: artichoke, celery, parsley. [French] Concours Med. 1964;86:3603-6
  11. Westbrook TG, Larsen LV, Vaughan TR. Food-induced anaphylaxis to parsley: A case report. Amer College Allergy Immunol 1992;62:16
  12. Kauppinen K, Kousa M, Reunala T. Aromatic plants a cause of severe attack of angioedema and urticaria. Contact Dermatitis 1980;6:251-254
  13. Kormil'tseva IV. Contact dermatitis due to parsley. [Russian] Vestn Dermatol Venerol 1982;(5):51-3
  14. Stransky L, Tsankov N. Contact dermatitis from parsley (Petroselinum). Contact Dermatitis 1980;6(3):233-4
  15. Luppi A, Bucci G. Epidemiological studies of morbidity in a rural community. 3. An occupational dermatitis in gardeners caused by celery and parsley. [Italian] Ig Mod 1970;63(11):617-23
  16. Egan CL, Sterling G. Phytophotodermatitis: a visit to Margaritaville. Cutis 1993;51(1):41-2
  17. Hehmann M, Lukacin R, Ekiert H, Matern U. Furanocoumarin biosynthesis in Ammi majus L. Eur J Biochem 2004;271(5):932-40
  18. Smith DM. Occupational photodermatitis from parsley. Practitioner 1985;229(1405):673-5
  19. Eckey-Kaltenbach H, Kiefer E, Grosskopf E, Ernst D, Sandermann H Jr. Differential transcript induction of parsley pathogenesis-related proteins and of a small heat shock protein by ozone and heat shock. Plant Mol Biol. 1997;33(2):343-50
  20. Lagey K, Duinslaeger L, Vanderkelen A. Burns induced by plants. Burns 1995;21(7):542-3
  21. Wang L, Sterling B, Don P. Berloque dermatitis induced by "Florida water". Cutis 2002;70(1):29-30
  22. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin Am J Health Syst Pharm 2000;57(13):1221-7
  23. Yarnell E. Botanical medicines for the urinary tract. World J Urol 2002;20(5):285-93
  24. Kreydiyyeh SI, Usta J. Diuretic effect and mechanism of action of parsley. J Ethnopharmacol 2002;79(3):353-7
  25. Ciganda C, Laborde A. Herbal infusions used for induced abortion. J Toxicol Clin Toxicol 2003;41(3):235-9
  26. Naimi TS, Wicklund JH, Olsen SJ, Krause G, Wells JG, Bartkus JM, Boxrud DJ, Sullivan M, Kassenborg H, Besser JM, Mintz ED, Osterholm MT, Hedberg CW. Concurrent outbreaks of Shigella sonnei and enterotoxigenic Escherichia coli infections associated with parsley: implications for surveillance and control of foodborne illness. J Food Prot 2003;66(4):535-41

 

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