Flaxseed allergy appearing more frequently – present in foods and other substances

ANAHEIM, Calif. (Nov. 9, 2023) – Flaxseed is an increasingly popular ingredient in baked goods and other food products due to its perceived health benefits. It is even used as a substitute for egg in some recipes. Two new medically challenging cases being presented at this year’s American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, Calif. show that flaxseed can cause allergic reaction – both after being ingested and also after touching the skin.

“Flaxseed allergy has been reported in adults, but not as often in children,” says Alana Xavier De Almeida, MD, ACAAI member and lead author of the paper, titled “IgE Mediated Flaxseed Allergy in Non-Atopic Toddler Polysensitized to Tree Nuts but Tolerating Other Seeds.” Dr. Xavier De Almeida is in training as an allergist. “We saw an 18-month-old patient with a rash throughout his face and chest 20 minutes after eating a packet of oatmeal with premixed flaxseed,” she says. “This was the first time the patient had eaten flaxseed, and the event self-resolved within 4 hours. A skin prick test was performed revealing positive results for various nuts and seeds, including flaxseed. Evaluation also included measurement of serum IgE levels. Based on the history and test results, a diagnosis of an IgE mediated reaction to flaxseed was made. A direct oral flaxseed challenge test was offered to confirm allergy but was never performed due to parents’ preference not to proceed.”

The second medically challenging case, titled, “Contact dermatitis of the hands caused by flaxseed in artist’s paint,“ involved a patient who was seen for recurrent rashes on her hands. The patient was an artist painting with oil paints. A history was obtained regarding items she used while painting including paint, charcoal, solutions to clean brushes and more. Review of items used showed that her oil paints contained Linseed/flaxseed-based oil as do many of the oil paints artists use.

“Her hand dermatitis was severe and disrupted her painting,” said allergist Richard Harris, MD, ACAAI member and lead author of the paper. “She exclusively used oils to paint. We asked her to bring all items and products she used while working on her art pieces. Patch testing was done using test wells taped on the back for 48 hours. Flaxseed reacted significantly at her patch test site at 48 and 72 hours.

Both flaxseed oil and linseed oil are derived from the dark brown seeds of the plant Linum Usitatissimum. Linseed oil is used in oil paint since it speeds up drying time and reduces visibility of brush strokes. In this case, it caused severe contact dermatitis, but it is also reported as an ingested allergen often seen in cereals and baked goods.”

Both cases illustrate that flaxseed, used in both food products and art supplies, should be considered as a trigger for an allergic reaction.

Medically Challenging Case Abstract Title: IgE Mediated Flaxseed Allergy in Non-Atopic Toddler Polysensitized to Tree Nuts but Tolerating Other Seeds

Presenter: Alana Xavier De Almeida, MD

Medically Challenging Case Abstract Title: Contact dermatitis of the hands caused by flaxseed in artist’s paint

Presenter: Richard Harris, MD

For more information about food allergies and anaphylaxis, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 9-13. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI23.

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M328

IGE MEDIATED FLAXSEED ALLERGY IN NON-ATOPIC TODDLER POLYSENSITIZED TO TREE NUTS BUT TOLERATING OTHER SEEDS
A. Xavier De Almeida^*1, T. Satnarine¹, H. Sampson², G. Kleiner¹, M. Gans¹, 1. Miami, FL; 2. New York, NY.

Introduction: The popularity of flaxseed consumption has grown significantly due to its reported health benefits, leading to an increase in allergic reactions associated with this seed. While hypersensitivity to flaxseed has been reported in adults, there is limited information regarding its effects on children.

Case Description: 18-month-old male non-atopic patient presented with a raised erythematous pruritic rash throughout his face and chest about 20 minutes after consuming an entire packet of oatmeal with premixed flaxseed. He consumed approximately 1800-2200 mg of flaxseed protein per manufacture. The event self-resolved within 4 hours. This was the first time that the patient orally ingested flaxseed.

Skin prick test was performed revealing positive results for various nuts and seeds, including flaxseed. Evaluation also included measurement of serum IgE levels (table 1), the flaxseed specific IgE was very high (15.20 kU_A/L, 47.50 kU_A/L) with a mildly elevated total IgE. Based on the history and test results, a diagnosis of an IgE mediated reaction to flaxseed was made. A direct oral flaxseed challenge test was offered to confirm allergy, but was never performed per parents’ preference.

Discussion: With the increasing use of flaxseed, allergists need to be aware of its potential to induce allergic reactions. Further research is necessary to investigate cross-reactivity between flaxseed and other nuts, legumes, and seeds, as well as establish the positive predictive values of flaxseed-specific IgE. Understanding these factors will aid in the diagnosis and management of flaxseed allergy, ensuring appropriate dietary recommendations for affected individuals.

M452

CONTACT DERMATITIS OF THE HANDS CAUSED BY FLAXSEED IN ARTISTS PAINT
R. Harris, M. Johnson,MD^*, Los Angeles, CA.

Introduction: This patient was referred to us for recurrent rashes on her hands. History revealed that she was an artist painting with oil paints. A history was obtained regarding items she used while painting including paint, charcoal, solutions to clean brushes and more.

Review of items used showed that her oil paints contained Linseed/flaxseed-based oil as do many of the oil paints artists use.

Case Description: Her hand dermatitis was severe and disrupted her painting. She exclusively used oils to paint. We asked her to bring all items and products she used while working on her art pieces. Patch testing was done using test wells taped on the back for 48 hours. The wells were removed at 48 hours and read for local reactions. The patient returned at 72 hours for a final reading (although reactions can occur in up to 7 days). Flaxseed reacted significantly at her patch test site at 48 and 72 hours.

Discussion: Both flaxseed oil and Linseed oil are derived from the dark brown seeds of the plant Linum Usitatissimu. Linseed oil is used in oil paint since it speeds up drying time and reduces visibility of brush strokes. In this case it caused severe contact dermatitis, but it is also reported as an ingested allergen often seen in cereals and baked goods.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374192/

https://jamanetwork.com/journals/jama/article-abstract/234846

Linseeds