Sage

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Code: f344
Latin name: Salvia officinalis
Family: Lamiaceae (former Labiatae)
Common names: Sage, Garden Sage, Salvia
Salvia divinorum (Sacred Sage, Sage of the Seers), native to Central America, is a hallucinogenic type of Sage. It was cultivated by Central American Indians for use in religious ceremonies.
 
Food
A food, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Garden sage originates from Asia Minor, North Africa, Spain and the Balkans, and grows wild along the Mediterranean coast. It has been a medicinal and culinary herb for thousands of years. The genus name, Salvia, comes from the Latin for ’cure’, and the dried plant is named Herba Salviae or ’the Herb of Healing’ in Latin.

Sage is a short-lived semi-woody, herbaceous perennial shrub growing up to 0.6 m tall, with blue, white or lilac flowers. It has intensely aromatic, thick, woolly, gray-green or multi-coloured oval leaves up to 8 cm long. They have conspicuous veins on the underside, and a characteristic lemony, slightly bitter and aromatic fragrance, somewhat like that of Rosemary.

Many cultivars exist, with leaves varying in size, and in colour from variegated gold and green to cream to red. Purpurascens, or Purple Sage, the most popular variety for medicinal uses, has leaves that are reddish-purple when young.

Sage is used extensively to add flavour to salads, stews, meats (especially sausages), stuffings, vegetables, vinegars and tea. Sage is also an ingredient in soaps, cosmetics and perfumes.

Sage is one of the most important medicinal herbs. It is used to treat digestive disorders and fevers and infections, particularly of the mouth. It is also used as an antiseptic and an antiperspirant. (1)

Allergen Description

No allergens from this plant have yet been characterised.

Potential Cross-Reactivity

An extensive cross-reactivity between the different individual species of the family could be expected (2) and has been suggested by clinical studies: in a report describing 3 systemic allergic reactions caused by oregano and thyme in the same patient, skin-specific IgE tests with plants of the Labiatae family (hyssop, basil, marjoram, mint, sage, lavender, etc.) were all positive when the skin-prick technique was used. Tests were negative with basil and lavender, and positive with all the others when the prick-by-prick technique was used. Serum-specific IgE was detected to all herbs tested. The study concluded that “plants belonging to the Labiatae family seem to show cross-sensitivity on the basis of clinical history and in vitro and in vivo test results.” (3)

In the latex-fruit syndrome, banana, avocado, chestnut and kiwi are the most frequently implicated foods, but associations with several other fruits and vegetables, including pineapple, fig, passion fruit, mango, tomato, bell pepper, carrot, oregano, dill, and sage have been reported. (4)

Clinical Experience

IgE-mediated reactions

Anecdotal evidence suggests that sage may induce symptoms of food allergy in sensitised individuals; (5) however, few studies have been reported to date. It is possible that the allergy occurs more frequently than has been reported. Skin contact with sage may result in contact dermatitis. (6)

A 65-year-old female reported experiencing an anaphylactic episode in the first 30 minutes after ingesting pesto genovese sauce (containing raw basil, pine nuts, garlic and olive oil, with or without parmesan cheese). She experienced generalised urticaria, angioedema and dyspnoea that resolved rapidly after treatment. She also experienced oral allergy syndrome (itching and burning mouth sensation) every time she ate oregano-seasoned Greek salad. Skin-prick tests to all Labiatae tested (basil, oregano, marjoram, sage, mint, thyme, lavender) were positive. She also tested positive to mugwort pollen. The study concluded that allergy to Labiatae may be observed in pollen-allergic patients and that allergy to a member of this plant family is not always followed by allergy to the other members. (7)

The presence of specific IgE to Sage may indicate sensitisation or cross-sensitisation without any evidence of clinical effects.

Other reactions

The effect of inhalation of Sage during tea processing has been evaluated previously. (8, 9) In a study examining ventilatory capacity and immunological reactions in 54 female workers employed in processing dried fruits and teas, there was higher prevalence of all chronic respiratory symptoms in exposed workers compared to control workers, although the differences were statistically significant for dyspnoea and rhinitis only. The exposed workers with positive skin IgE had a significantly higher prevalence of dyspnoea and rhinitis than those with no skin-specific IgE. In exposed workers there were statistically significant acute reductions of ventilatory capacity in tests performed during the work shift. A significantly larger number of exposed workers compared to controls demonstrated skin-specific IgE to at least one of the occupational allergens, but only the prevalence of positive skin-specific IgE to Sage (60%) was significantly higher than in control workers (20%). (4)

People occupationally exposed to dust from herbs, including sage, were shown to have a higher frequency of positive skin reactions to microbial antigens compared to a control group. (10)

 

Compiled by Dr Harris Steinman.

References

  1. Daniela T. Salvia officinalis l. I. Botanic characteristics, composition, use and cultivation. [Slovak] Cesk Farm 1993;42(3):111-6.
  2. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09.
  3. Benito M, Jorro G, Morales C, Pelaez A, Fernandez A. Labiatae allergy: systemic reactions due to ingestion of oregano and thyme. Ann Allergy 1996;76(5):416-8.
  4. Asero R, Mistrello G, Roncarolo D, Amato S, Falagiani P. Detection of novel latex allergens associated with clinically relevant allergy to plant-derived foods J Allergy Clin Immunol 2005 Jun;115(6):1312-4.
  5. Zuskin E, Kanceljak B, et al. Ventilatory function and immunologic reactions in female workers processing dried fruits and teas. [Croatian] Lijec Vjesn 1996;118(5-6):113-7.
  6. Futrell JM, Rietschel RL. Spice allergy evaluated by results of patch tests. Cutis 1993;52(5):288-90.
  7. Vartholomaios S, Pitsios C, Lefousis C, Mikos N, Kompoti E, Kouridakis S. Coexisting allergy to basil and oregano presentation of two case reports. EAACI Congress, Vienna-Austria. 2006 Jun; Oral Abstract 529.
  8. Blanc PD, Trainor WD, Lim DT. Herbal tea asthma. Br J Ind Med 1986;43(2):137-8.
  9. Zuskin E, Kanceljak B, Skuric Z, Ivankovic D. Immunological and respiratory changes in tea workers. Int Arch Occup Environ Health 1985;56(1):57-65.
  10. Golec M, Skórska C, Mackiewicz B, Dutkiewicz J. Immunologic reactivity to work-related airborne allergens in people occupationally exposed to dust from herbs. Ann Agric Environ Med 2004;11(1):121-7.

 

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