Paprika/Sweet Pepper

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Code: f218
Latin name: Capsicum annuum
Source material: Dried fruit (powder)
Family: Solanaceae
Common names: Sweet Pepper, Paprika, Bell Pepper, Green Pepper, Hungarian Pepper, Red Pepper, Pimento, Pimiento
Two unrelated families have members called Pepper: Solanaceae, the Potato family, and Piperaceae, the Pepper family, including White and Black Pepper.
 
The latter, which are condiments and spices, are made from unripe peppercorns from the Piper Nigrum plant and sold dried, crushed, or pickled in vinegar or brine.
 
Confusion is possible between the Peppers C. frutescens and C. annuum, especially since C. annuum includes Red Peppers that are the source of hot-flavoured Paprika and other spices and condiments. Furthermore, the spice Capsicum can be derived from both species, from C. annuum principally, and from C. frutescens L. to a lesser extent.
 
Food
A food, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Geographical distribution
Probably native of the tropics, Sweet Peppers are grown mainly in China; the Dominican Republic, Haiti, Hawaii, Iraq, Japan, Malaya, Mexico, Spain, Hungary and Turkey. Most commercial Paprika comes from Spain, South America, California and Hungary, with the Hungarian variety considered by many to be superior. It is used as a spice in many cuisines worldwide.
 
C. annuum (Sweet Pepper), as opposed to C. frutescens (Chili or Cayenne Pepper), is used mainly as a vegetable. It usually has a mild, sweet flavor, and is eaten raw or cooked. It also serves as a source of condiments and spices, especially in dishes of Latin America and the East.
 
Environment
Not known in the wild, Sweet Peppers are grown in cultivated beds. The flavour can range from mild to pungent and hot, the color from green to deep blood-red to pink. Peppers are often found as a vegetable in stews and salads. Jalapeno Pepper is a variety of this species, and is used both as a condiment and in the making of green Tabasco sauce; another very hot red variety goes into red Tabasco sauce. Special red varieties are dried to make Paprika powder, which is relatively mild compared to Chili powder. Paprika is used as a seasoning and garnish for a plethora of savoury dishes, and sometimes serves as a food colouring. Young leaves of the plant are steamed as a potherb or added to soups and stews. The flowers can be eaten raw or cooked.
 
Peppers are a good source of dietary antioxidants, apart from other widespread compounds (flavonoids, phenolic acids, carotenoids, vitamin A, ascorbic acid, tocopherols), and also contain specific constituents such as the pungent capsaicinoids (capsaicin, dihydrocapsaicin, and their analogues).
 
The fruit of the Pepper may be used as a herbal remedy for a variety of conditions, including as an ingredient in a topical Capsicum-based product for the treatment of lower back pain and otitis media. The oleoresin of capsicum has been used as a riot control agent.
 
Unexpected exposure
Capsaicin is a major pungent ingredient of Capsicum fruits such as Green and Red Peppers. Capsaicin is used as a food additive or as an over-the-counter topical agent for treatment of post-herpetic neuralgia, diabetic neuropathy, and arthritis (1). Capsaicin present in Paprika may be implicated in the bronchoconstriction of airways (2) and has also been found to increase permeability in a model of human intestinal epithelium (3).
 
Allergens
The following allergens have been fully characterised:
  • Cap a 1, a thaumatin-like protein (4) 
     
  • Cap a 1w, an osmotin-like protein; homolog: pathogenesis-related protein PR5

Also profilin and a Bet v 1 homologue have been detected in Sweet Pepper (5). Examination of a variety of horticultural strains of Sweet Peppers demonstrated the presence of profilin in all and Bet v 1homologues in 50%, suggesting that Sweet Peppers have to be considered potentially dangerous for Bet v 1- and profilin-sensitised patients. In 4 of 8 horticultural strains of Sweet Peppers, a homologue of the osmotin-like protein P23 from Tomatoes was responsible for substantial IgE binding (6-7). The P23 allergen appears to be a 23 kDa allergen. Other uncharacterised allergens detected were of a higher molecular weight (7).

A beta-1,4-glucanase, a cell wall-associated enzyme believed to function in fruit ripening, has been isolated from Sweet Pepper (8). This enzyme in other plants has been shown to have allergenic activity, but its allergenic relevance in Sweet Pepper has not yet been determined.

Potential Cross-Reactivity

An extensive cross-reactivity among the different individual species of the genus could be expected (9). Antigenically crossreactive material from tobacco leaf was demonstrated in Eggplants, Sweet pepper, Potato, and Tomato; all members of the family Solanaceae (10).
 
Cross-reactivity to other plants containing the panallergens profilin and Bet v 1 homologues can be expected to occur frequently. Patients with allergy to Sweet Pepper and associated pollinosis show a high frequency of IgE reactivity to profilin (11-12). Although some strains of Sweet Pepper contain a homologue of the osmotin-like protein P23 from Tomatoes, which in vitro is responsible for substantial IgE binding (6, 7), the clinical relevance of this allergen has yet to be determined.
 
A high frequency of sensitisation to Sweet Pepper has been frequently reported in Latex-allergic patients (11, 13-14). Approximately 30-50% of individuals who are allergic to Natural Rubber Latex show an associated hypersensitivity to some plant-derived foods, especially freshly consumed fruits. This association is called Latex-fruit syndrome. An increasing number of plant sources, such as Avocado, Banana, Chestnut, Kiwi, Peach, Tomato, Potato and Sweet Pepper, have been associated with this syndrome. Several types of proteins have been implicated: class I chitinases which cross-react with prohevein, and a beta-1,3-glucanase (11, 15). Children allergic to Natural Rubber Latex often show allergenicity to Sweet Pepper (16).
 
By ELISA-inhibition assays, a partial cross-reactivity was found among IgE-binding components from Paprika and Mace, but the clinical relevance of this has not been determined (17).

Clinical Experience

IgE-mediated reactions
Sweet Pepper or spices made from Sweet Pepper may induce symptoms of food allergy, rhinitis and contact dermatitis in sensitised individuals (6, 18-22). Urticaria as a result of contact with Paprika has been documented (23). Specific IgE antibodies to Sweet Pepper have been measured by Phadebas RAST (24).
 
A 27-year-old individual who developed rhinitis and asthma symptoms when preparing a spiced sausage was reported. Skin-specific IgE was detected to Paprika, Coriander, and Mace but not to other ingredients of sausage. Serum-specific IgE to Paprika, Coriander, and Mace were demonstrated. Specific bronchial inhalation challenges showed an immediate asthmatic reaction to extracts from Paprika, Coriander, and Mace, with a maximum fall in FEV1 of 26%, 40%, and 31%, respectively, and with no late asthmatic reactions (17).
 
The complexity of the relationship of allergens, the degree of individual variability, and the severity of the reactions are illustrated by a spice-and-condiment seller who experienced occupational-related anaphylaxis and concurrent rhinoconjunctivits caused by intake of Sweet Pepper. The patient tolerated other Solanaceae products, and attempts to inhibit IgE binding to Capsicum by other Solanaceae members failed (25).
 
In a study reporting on 7 cases of food-dependant exercise-induced anaphylaxis, the responsible foods were Wheat (2 cases), Maize, Barley, Shrimp, Apple, Paprika and Mustard (26).
 
Various components of Sweet Pepper may result in occupational disease (27).
 
Among 472 Sweet Pepper greenhouse employees, work-related symptoms were reported in 53.8%. Sensitisation to the Sweet Pepper plant was found in 35.4%. Positive reactions to leaf, stem and/or juice, however, were associated in nearly 90% with sensitisation to pollen, which appeared to be the most important allergen of the plant. Symptoms at work were found to be associated with an IgE-mediated allergy due to the high and chronic exposure to Sweet Pepper pollen (28).
 
Contact dermatitis, contact allergy and protein contact dermatitis have been frequently reported (29-31). A group of 103 patients with suspected contact allergy to spices was tested with the European standard series. Among the spices, the highest numbers of reactions were found to Nutmeg (28%), Paprika (19%) and Cloves (12%) (30). This study suggested that IgE-mediated immediate-type responses are directed against different antigens from those eliciting delayed responses.
 
Occupational contact urticaria from Paprika may also occur (32), and protein contact dermatitis from Paprika and curry has been reported in a cook with no history of atopy. He was found to have elevated total IgE and a high level of specific IgE to Sweet Pepper as tested by the Pharmacia CAP System. The results correlated well with a skin prick test (31).
 
Other reactions
See also under Unexpected Exposure. Pungent-fruited Peppers may cause painful irritation when used in excess, or after accidental contact with the eyes. Pepper spray containing oleoresin capsicum is used by law enforcement and the public as a form of nonlethal deterrent but may result in corneal abrasions if in contact with the eyes (33). The sap of the plant can cause the skin to blister.
 
Erythema multiforme-like contact dermatitis has been reported (34).
 
Protection against thrips, a common pest in Sweet Pepper horticulture, is effectively possible without pesticides through use of the commercially available predatory mite Amblyzeius cucumeris. This mite is a new occupational allergen in horticulture, which may result in IgE-mediated allergy in exposed employees. In a group of Sweet Pepper horticultural workers, work-related symptoms were reported by 76.1%. Skin-specific IgE to this mite was found in 23% (109) of this group. Sensitisation to Tyrophagus putrescentiae was found in 62 employees, of whom 48 were also sensitised to A. cucumeris (35).
 
Serum-specific IgE against Paprika pollen, but not against Tomato pollen, was found in serum from 2 greenhouse workers who worked with Paprika plants. A greenhouse worker who cultivated Tomato plants had IgE against both Tomato and Paprika pollen. The authors conclude that the presence of IgE against Paprika or Tomato pollen is not restricted to workers in horticulture; IgE against these pollens can also be present in food-allergic patients who have serum IgE against Paprika and/or Tomato fruit (36). 
 
Compiled by Dr Harris Steinman, harris@zingsolutions.com

References

  1. Williams SR, Clark RF, Dunford JV. Contact dermatitis associated with capsaicin: Hunan hand syndrome. Ann Emerg Med 1995;25(5):713-5
  2. Zuskin E, Kanceljak B, Skuric Z, Pokrajac D, Schachter EN, Witek TJ, Maayani S. Immunological and respiratory findings in spice-factory workers. Environ Res 1988; 47: 95-108.
  3. Jensen-Jarolim E, Gajdzik L, Haberl I, Kraft D, Scheiner O, Graf J. Hot spices influence permeability of human intestinal epithelial monolayers. J Nutr 1998;128(3):577-81
  4. Hoffmann-Sommergruber K., Witty M., Campillo N., Krebitz M., Fuchs H., et al. Pru P 2, MAL D 2 and CAP A 1 are members of the thaumatin family and allergens: common structural features [Poster] 8th International Symposium on Problems of Food Allergy 2001,ch 11-13, Venice
  5. Ebner C, Jensen-Jarolim E, Leitner A, Breiteneder H. Characterization of allergens in plant-derived spices: Apiaceae spices, pepper (Piperaceae), and paprika (bell peppers, Solanaceae). Allergy 1998;53(46 Suppl):52-4
  6. Jensen-Jarolim E, Santner B, Leitner A, Grimm R, Scheiner O, Ebner C, Breiteneder H. Bell peppers (Capsicum annuum) express allergens (profilin, pathogenesis-related protein P23 and Bet v 1) depending on the horticultural strain. Int Arch Allergy Immunol 1998;116(2):103-9
  7. Leitner A, Jensen-Jarolim E, Grimm R, Wuthrich B, Ebner H, Scheiner O, Kraft D, Ebner C. Allergens in pepper and paprika. Immunologic investigation of the celery-birch-mugwort-spice syndrome. Allergy 1998;53(1):36-41
  8. Harpster MH, Lee KY, Dunsmuir P. Isolation and characterization of a gene encoding endo-beta-1,4-glucanase from pepper (Capsicum annuum L.). Plant Mol Biol 1997;33(1):47-59
  9. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala. Sweden. 1982: ISBN 91-970475-09
  10. Becker CG, Dubin T, Wiedemann HP. Hypersensitivity to tobacco antigen. Proc Natl Acad Sci U S A 1976;73(5):1712-1716
  11. Wagner S, Breiteneder H. The latex-fruit syndrome. Biochem Soc Trans 2001;30(6):935-40
  12. Paschke A, Kinder H, Zunker K, Wigotzki M, Steinhart H, Wessbecher R, Vieluf I. Characterization of cross-reacting allergens in mango fruit. Allergy 2001;56(3):237-42
  13. Gallo R, Cozzani E, Guarrera M. Sensitization to pepper (Capsicum annuum) in a latex-allergic patient. Contact Dermatitis 1997;37(1):36-7
  14. Maillard H, Drouet M, Sabbah A. Allergy associated with pepper and latex: new cross reaction? [French] Allerg Immunol (Paris) 1995;27(8):292-4
  15. Gallo R, Roncarolo D, Mistrello G. Cross-reactivity between latex and sweet pepper due to prohevein. Allergy 1998;53(10):1007-8
  16. Tucke J, Posch A, Baur X, Rieger C, Raulf-Heimsoth M. Latex type I sensitization and allergy in children with atopic dermatitis. Evaluation of cross-reactivity to some foods. Pediatr Allergy Immunol 1999;10(3):160-7
  17. Sastre J, Olmo M, Novalvos A, Ibanez D, Lahoz C. Occupational asthma due to different spices. Allergy 1996;51(2):117-20
  18. Anliker MD, Borelli S, Wuthrich B. Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome. Contact Dermatitis 2002;46(2):72-4
  19. Niinimaki A, Hannuksela M, Makinen-Kiljunen S. Skin prick tests and in vitro immunoassays with native spices and spice extracts. Ann Allergy Asthma Immunol 1995;75(3):280-6
  20. Meding B. Skin symptoms among workers in a spice factory. Contact Dermatitis 1993;29(4):202-5
  21. Rubin HR, Wu AW, Tunis S. WARNING--inhaling tabasco products can be hazardous to your health. [Letter] West J Med 1991;155(5):550
  22. van Toorenenbergen AW, Dieges PH. Occupational allergy in horticulture: demonstration of immediate-type allergic reactivity to freesia and paprika plants. Int Arch Allergy Appl Immunol 1984;75(1):44-7
  23. Eseverri JL, Cozzo M, Castillo M, Marin A. Round Table: Immunological urticaria mediated by IgE. [Spanish] Allergol Immunopathol (Madr) 1999;27(2):104-11
  24. Stäger J, Wüthrich B, Johansson SGO. Spice allergy in celery-sensitive patients. Allergy 1991;46:475-8.
  25. Vega de la Osada F, Esteve Krauel P, Alonso Lebrero E, Ibanez Sandin MD, Munoz Martinez MC, Laso Borrego MT. Sensitization to paprika: anaphylaxis after intake and rhinoconjunctivitis after contact through airways. [Spanish] Med Clin (Barc) 1998;111(7):263-6
  26. Mathelier-Fusade P, Vermeulen C, Leynadier F. Responsibility of food in exercise-induced anaphylaxis: 7 cases. [French] Ann Dermatol Venereol 2002;129(5 Pt 1):694-7
  27. Uragoda CG. Chilli grinding as an opening to the study of occupational lung disease. Ceylon Med J 2000;45(4):159-60
  28. Groenewoud GC, de Jong NW, van Oorschot-van Nes AJ, Vermeulen AM, van Toorenenbergen AW, Mulder PG, Burdorf A, de Groot H, van Wijk RG. Prevalence of occupational allergy to bell pepper pollen in greenhouses in the Netherlands. Clin Exp Allergy 2002;32(3):434-40
  29. Burnett JW. Capsicum pepper dermatitis. Cutis 1989;43(6):534
  30. van den Akker TW, Roesyanto-Mahadi ID, van Toorenenbergen AW, van Joost T. Contact allergy to spices. Contact Dermatitis 1990;22(5):267-72
  31. Hafner J, Riess CE, Wuthrich B. Protein contact dermatitis from paprika and curry in a cook. Contact Dermatitis 1992;26(1):51-2
  32. Foti C, Carino M, Cassano N, Panebianco R, Vena GA, Ambrosi L. Occupational contact urticaria from paprika. Contact Dermatitis 1997;37(3):135
  33. Brown L, Takeuchi D, Challoner K. Corneal abrasions associated with pepper spray exposure. Am J Emerg Med 2000;18(3):271-2
  34. Raccagni AA, Bardazzi F, Baldari U, Righini MG. Erythema-multiforme-like contact dermatitis due to capsicum. Contact Dermatitis 1995;33(5):353-4
  35. Groenewoud GC, de Graaf in 't Veld C, vVan Oorschot-van Nes AJ, de Jong NW, Vermeulen AM, van Toorenenbergen AW, Burdorf A, de Groot H, Gerth van Wijk R. Prevalence of sensitization to the predatory mite Amblyseius cucumeris as a new occupational allergen in horticulture. Allergy 2002;57(7):614-9
  36. van Toorenenbergen AW, Waanders J, Gerth Van Wijk R, Vermeulen AM. Immunoblot analysis of IgE-binding antigens in paprika and tomato pollen. Int Arch Allergy Immunol 2000;122(4):246-50 

 

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