Cabbage

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Code: f216
Latin name: Brassica oleracea var. capitata
Source material: Whole head of cabbage
Family: Brassicaceae
Common names: Cabbage, Head cabbage, Heading cabbage

Allergen Exposure

Geographical distribution
Cabbage, a cultivar of wild cabbage, is a plant of the Cabbage family, Brassicaceae (formerly Cruciferae). Cabbage originated in the Mediterranean and Adriatic regions as a loose-leafed wild plant, from a leafy wild cabbage/wild mustard plant. It was domesticated and eventually bred into widely varying forms, including Cabbage, Broccoli, Cauliflower, kale, kohlrabi, and Brussels sprouts, all of which remain the same species (1-2).

“Cabbage” is the common term for those members of the Cabbage family of which the leaves and not the flower heads are normally eaten. These Cabbages are biennials growing up to 0.75 m. Among these plants, the shapes can be flat, conical or round, the heads compact or loose, and the leaves curly or plain. But most varieties of Cabbage have a short, broad stem and leaves or flowers that form a compact head. These hard-headed Cabbages were developed in 16th century. The main growing areas are Western Europe and the Baltic countries, the ex-USSR, China, Japan and the US. By careful selection of cultivars, it is possible to harvest Cabbages all year round.

Environment
Cabbage is not known in the wild, and grows only in cultivated beds. Its leaves are generally used as a cooked vegetable (often appearing in soups and stews), though the shredded leaves can also be eaten in salads, especially with mayonnaise and other ingredients as coleslaw. The sprouts can also be added to salads. The leaves can be fermented and made into sauerkraut, used as a health food and said to be good for the digestive system. Cabbage contains a fair amount of vitamin C and fibre, and some vitamin A.

Raw Cabbage juice has been used as a peptic ulcer treatment, due to its S-methylmethionine content. But the juice, if consumed in excess, begins to inhibit iron absorption. Cabbage has also been used to help prevent cancer of the colon.

Unexpected exposure
A blue dye can be obtained from the leaves of purple cultivars.

Allergens
In the case of an atopic 21-year-old woman who had anaphylaxis to Cabbage, allergenic activity was demonstrated by RAST-inhibition in 2 fractions of the Cabbage extract: a fraction of intermediate molecular weight (between 45 and 67 kDa) and a fraction of low molecular weight (< 45 kDa) (3).

The following allergen have been characterised:

  • Bra o 3, a 9 kDa lipid transfer protein, a heat stable allergen (4-5).

Among 17 patients allergic to Cabbage, skin prick testing with the lipid transfer protein Bra o 3 was positive in 12 of 14 cases (86%) (4).

Chitinase has been purified from an extract of Cabbage and Cabbage stems with roots (6-7). The clinical significance of this allergen in Cabbage has not been determined to date, but there may be antigenic properties similar to those of the panallergen chitinase in other foods.

Potential cross-reactivity

An extensive cross-reactivity among the different individual species of the genus could be expected, as well as to a certain degree among members of the family Brassicaceae, such as Broccoli, Cauliflower, Brussels sprouts, and Cabbage (8). This has been supported by a study that reported cross-reactivity among Cabbage, Broccoli, Cauliflower, Mustard, Rape and Turnip (3). Ortolani et al. differ and state that cross-reactivity among the Brassicaceae species is rare (9).

Among 17 patients allergic to Cabbage, most showed associated sensitisation to Mugwort pollen, Mustard, and Peach. A lipid transfer protein (Bra o 3) with 50% identity to Peach lipid transfer protein, Pru p 3, was demonstrated. Bra o 3 inhibited significantly the IgE binding to Cabbage, Mugwort pollen, and Peach (4). A lipid transfer protein has been isolated from a close family member, Broccoli (10). Cross-reactivity among plants containing LTP is possible (11).

A chitinase has been isolated from Cabbage. The potency of this allergen in Cabbage has not yet been determined, but there may be cross-reactivity with other plants containing the panallergen chitinase (6-7).

Clinical Experience

IgE-mediated reactions
Cabbage can occasionally induce symptoms of food allergy in sensitised individuals (3-4,12-13).

Proteins of these vegetables may cause immediate-type allergy, the pollens may be involved in hay fever (14), and skin contact with the isothiocyanates released may cause contact dermatitis (15).

In all of 17 patients allergic to Cabbage, SPT and IgE antibody tests were positive to Cabbage. Five experienced anaphylactic reactions when eating Cabbage, and in another 5, Cabbage allergy was further confirmed by double-blind placebo-controlled food challenges. Skin prick tests with the isolated lipid transfer protein Bra o 3 were positive in 12 of 14 cases (86%) (4).

Anaphylaxis was reported in a woman, who experienced facial and throat swelling after the ingestion of coleslaw on 2 separate occasions. IgE antibody level to Cabbage was raised. She also demonstrated skin reactivity to other members of the Brassicaceae family: Mustard plant, Cauliflower, and Broccoli. The authors suggest that allergy to this vegetable is more common than believed (3).

An Indian study evaluated the possible effect of a specific elimination diet on symptoms of 24 children aged 3 to 15 years with documented deterioration in control of their perennial asthma. IgE antibody analysis for a range of food items found that 8 (33%) of the subjects had IgE antibodies directed at Cabbage (16).

Occupational asthma due to the inhalation of Cauliflower and Cabbage vapours was reported in a 41-year-old woman. She experienced recurrent episodes of ocular and nasal itching, sneezing, watery nose, tearing, dry cough, chest tightness, and dyspnoea within a few minutes after inhaling cooking vapours of Cauliflower and Cabbage in a hotel kitchen. She had previously also reported an acute episode of generalised urticaria and facial and oropharyngeal angioedema 6 hours after eating Cabbage. SPT was positive for raw and stewed Cauliflower, Cabbage and Radish, and negative for Turnip, Brussels sprouts, Mustard, cress, and Broccoli. IgE antibody tests were positive for Cabbage, Brussels sprouts, Broccoli, Cauliflower and Oilseed rape, and negative for Mustard. An inhalation challenge to boiling Cauliflower was positive (12).

A report was made of anaphylaxis in a 20-year-old girl following ingestion of String bean; the report also described her developing urticaria from fresh Fennel, boiled Cabbage, Mustard, commercial Hazelnut, and commercial Pear juice (17).

Contact urticaria from Cabbage has been reported (18). IgE antibodies and positive skin tests to Cabbage were also found in cases of contact urticaria (19), and in adult patients with immediate symptoms after intake of vegetables (20).

Other reactions

Maternal intake of Cabbage, Cauliflower, Broccoli, Cow’s milk, Onion, and chocolate were significantly related to colic symptoms in exclusively breast-fed infants (21).

Pickled Cabbage (sauerkraut) contains high levels of histamine, which may result in histamine reactions (22).

Compiled by Dr Harris Steinman, developer of Allergy Advisor, http://allergyadvisor.com.

References

  1. Wikipedia contributors, ”Broccoli,” Wikipedia, The Free Encyclopedia, http://en.wikipedia.org/w/index.php?title=Broccoli&oldid=236472388 (accessed September 8, 2008)
  2. Wikipedia contributors, ’Cabbage’, Wikipedia, The Free Encyclopedia, 6 September 2008, 18:17 UTC, <http://en.wikipedia.org/w/index.php?title=Cabbage&oldid=236697016> [accessed 8 September 2008]
  3. Blaiss MS, McCants M, Lehrer S. Anaphylaxis to cabbage: detection of allergens.
    Ann Allergy 1987;58:248-50                    
  4. International Union of Immunological Societies Allergen Nomenclature: IUIS official list http://www.allergen.org/List.htm 2008
  5. Palacin A, Cumplido J, Figueroa J, Ahrazem O, Sanchez-Monge R, Carrillo T, Salcedo G, Blanco C. Cabbage lipid transfer protein Bra o 3
    is a major allergen responsible for cross-reactivity between plant foods and pollens.
    J Allergy Clin Immunol 2006;117(6):1423-9
  6. Chang CT, Hsueh YL, Sung HY. Purification and properties of chitinase from cabbage stems with roots.
    Biochem Mol Biol Int 1996;40(2):417-25
  7. Chang CT, Lo HF, Wu CJ, Sung HY. Purification and properties of chitinase from cabbage. Biochem Int 1992;28(4):707-15
  8. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09
  9. Ortolani C, Ispano M, Ansaloni R, Rotondo F, Incorvaia C, Pastorello EA Diagnostic problems due to cross-reactions in food allergy.
    Allergy 1998;53:(Suppl 46):58-61
  10. Asero R, Mistrello G, Roncarolo D, Amato S, van Ree R. A case of allergy to beer showing cross-reactivity between lipid transfer proteins. Ann Allergy Asthma Immunol 2001;87(1):65-7
  11. Asero R, Mistrello G, Roncarolo D, de Vries SC,
    Gautier MF, Ciurana CL, Verbeek E, Mohammadi T, Knul-Brettlova V, Akkerdaas JH,
    et al. Lipid transfer protein: a pan-allergen in plant-derived foods that is highly resistant to pepsin digestion.
    Int Arch Allergy Immunol 2000;122(1):20-32
  12. Quirce S, Madero MF, Fernandez-Nieto M, Jimenez A, Sastre J. Occupational asthma due to the inhalation of cauliflower and cabbage vapors. Allergy 2005;60(7):969-70
  13. Zuidmeer L, Goldhahn K, Rona RJ, Gislason D, Madsen C, Summers C, Sodergren E, Dahlström J, Lindner T, Sigurdardottir ST, McBride D, Keil T. The prevalence of plant food allergies: a systematic review.
    J Allergy Clin Immunol 2008;121(5):1210-8
  14. Hemmer W, Focke M, Wantke F, Jager S, Gotz M, Jarisch R. Oilseed rape pollen is a potentially relevant allergen.
    Clin Exp Allergy 1997;27(2):156-61
  15. Dannaker CJ, White IR. Cutaneous allergy to mustard in a salad maker.
    Contact Dermatitis 1987;16(4):212-4
  16. Agarkhedkar SR, Bapat HB, Bapat BN. Avoidance of food allergens in childhood asthma. Indian Pediatr. 2005; 42(4):362-366.
  17. Asero R, Mistrello G, Roncarolo D, Amato S, van Ree R. String bean-induced anaphylaxis. Allergy 2001;56(3):259-60
  18. Calnan CD. Contact urticaria from cabbage (Brassica). Contact Dermatitis 1981;7(5):279
  19. Galindo PA, Feo F, Garcia R, et al. Contact urticaria from stock, a cruciferae plant.
    Allergy 1996;51(5):363-4
  20. Caballero T, Martin-Esteban M, Garcia-Ara C, Pascual C, Ojeda A. Relationship between pollinosis and fruit or vegetable sensitization. Pediatr Allergy Immunol 1994;5(4):218-22
  21. Lust KD, Brown JE, et al. Maternal intake of cruciferous vegetables and other foods and colic symptoms in exclusively breast-fed infants. J Am Diet Assoc 1996;96(1):46-8
  22. Wantke F, Gotz M, Jarisch R. Histamine-free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronic headaches.
    Clin Exp Allergy 1993;23(12):982-5

 

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