This article has been reviewed by Thanai Pongdee, MD, FAAAAI

The addition of spices and other additives to foods is extremely common. Spices are derived from plants and therefore have the potential to be allergens. They are often suspected as the trigger for allergic reactions, but allergic antibody mediated reactions are believed to be very rare. Most of the reactions patients have are not true allergic reactions (due to allergic antibody formation to the actual spice) and may represent non-allergic reactions consistent with “intolerances.” This is important to differentiate as true antibody mediated reactions can be life threatening, while a non-allergic reaction is likely to be self-limited (or in other words, ultimately resolving itself without treatment).

The following are types of reactions reported with spices:

Non-Allergic Reactions
•    Rash on the skin. Spices have properties that cause irritation on the skin and resulting rash.
Example: Cinnamon can cause a local rash where it touches the skin.
•    Itching in the mouth. These types of reactions are often due to a cross reactivity with pollens. In essence, the allergy is not to the actual spice, but to the pollen, which can cause a localized itch in the mouth.
Example: Reaction to fresh tarragon, but due to allergy to a type of weed.
•    Cough due to inhalation. This type of reaction is likely due to an irritant effect, rather than a true allergy.
Example: Black pepper can cause cough or can trigger asthma symptoms in patients with asthma.

Allergic Reactions
•    Anaphylaxis (severe allergic reaction). Although extremely rare, anaphylaxis has been reported with some spices. These reactions are consistent with true allergy. Case reports have described these types of reactions with oregano, thyme, coriander, caraway seed and cumin.
•    Sesame seed is a more traditional food allergen and may be contained in spice mixtures. A reaction may be attributed to a true food allergy, and it can be life threatening. For patients known to be allergic to sesame, care should be taken in avoiding spices with sesame as an ingredient.

If a particular spice has been consistently causing symptoms, an allergist / immunologist should be consulted. In most cases, the reaction to a spice will be due to a non-allergic cause.

Skin prick testing (either with commercial extract or from the actual spice itself) may be used to determine if there is allergic antibody present to the spice. In some cases, a challenge (a supervised graded feeding) may be conducted in the allergist’s office to determine whether the patient could tolerate the spice in the future.