Pubdate: Thu, 23 Jul 2015
Source: Alaska Dispatch News (AK)
Column: Highly Informed
Copyright: 2015 Alaska Dispatch Publishing
Contact:  http://www.adn.com/
Details: http://www.mapinc.org/media/18
Note: Anchorage Daily News until July '14
Author: Scott Woodham

COULD POT-INFUSED EDIBLES BE CAUSING MY RUNNY NOSE AND SNEEZING?

Chris wonders after a previous Highly Informed column noted that 
alternatives to smoking cannabis aren't without potential risks: 
"I've been a daily user of edibles and am feeling like I've become 
allergic: runny nose, stuffed sinus, sneezing etc. Is this a possible 
side effect?"

First off, it is possible for people to be allergic to cannabis, and 
the indications so far are that such allergies respond to common 
treatments. Cannabis, like many other plants, weeds and grasses, can 
cause the immune system to overreact in defense. That overreaction is 
what we call an allergy. An extreme kind of allergic reaction is 
known as anaphylaxis. It is severe and life-threatening, and can come 
upon someone in seconds. In anaphylaxis, the flood of chemicals sent 
by the body can cause symptoms like shock, constriction of the airway 
and decrease in blood pressure.

A range of symptoms are associated with allergic reactions, but they 
do include the ones you describe there. Dr. Phil Lieberman, who 
fields questions from allergists for the American Academy of Allergy, 
Asthma & Immunology, reviewed the literature and concluded in a 2012 
column, "marijuana is capable of producing allergic reactions both in 
the respiratory tract via its pollination and by ingestion, causing 
anaphylaxis." Since that column, a one-of-a-kind case of anaphylaxis 
through inhalation has appeared.

Cases of allergic reactions associated with cannabis are thought to 
have resulted from both THC and to proteins found in the cannabis 
plant. But, said Dr. Melinda Rathkopf of the Allergy, Asthma and 
Immunology Center of Alaska, symptoms like the sort Chris describes 
would be unusual as a result of ingesting an allergen in food.

She said in a phone interview that cannabis is associated with cases 
of contact allergies (which result from touching something) and 
pollen allergies (inhaling something), but that hay-fever like 
symptoms, known as rhinitis, are unlikely to be the result of eating 
something. Runny noses and sneezing are more likely to result from 
inhaling pollen, she said, the same way birch trees turn noses across 
Alaska into faucets in spring and summer.

Rathkopf said she can't rule out that Chris is allergic to cannabis, 
but that his symptoms indicate some cause besides the edibles. For 
example, she said, he might be experiencing a contact or pollen 
allergy if he has buds or leaves around and handles them.

It's important to note that "pollen" in this context refers to 
microscopic particles of protein that float around and cause problems 
for the human respiratory tract. While most of the pollen in the air 
does come from male plants, the term does not necessarily only refer 
to something from a male plant. Male cannabis plants are far more 
likely for someone to encounter in places like the Midwest, where 
cannabis grows wild in ditches as a hold-over from historic hemp 
production, compared to a place like Alaska, where most plants are 
female and grown indoors to produce seedless flowers. Indoor growers 
for recreational and medical use typically kill male plants as soon 
as they appear so that a crop doesn't develop seeds.

Testing?

So it is possible that an allergy to cannabis is causing Chris's 
symptoms, but maybe not, and it's probably not the infused food.

According to Lieberman, if cannabis is related to your symptoms, you 
could even be allergic to aspergillus, a mold that can sometimes be 
found on finished buds and can appear in grows.

Lieberman has written a couple of explainers for the AAAAI, (linked 
here and here), but grab a medical dictionary if you decide to tackle 
them. Other physicians and experts make up his audience, not 
laypeople. He notes in one entry that a complete classification of 
the allergens in pot hasn't been created, but that one allergen 
present in other foods and pollens has been identified.

So how does anyone tell for sure whether they're allergic to pot? 
Well, it's difficult. The clinical study of cannabis allergies is, 
like many areas of cannabis research, still progressing. As a 
recently published review in the journal Annals of Allergy Asthma and 
Immunology notes, diagnosis of cannabis allergy is still heavily 
reliant on factors besides standardized clinical testing.

For a variety of reasons, there is no commercialized test yet for a 
cannabis allergy, but Dr. Rathkopf said that people testing allergic 
to weeds in general means they're more likely to be allergic to 
cannabis. And she has heard of cases where people who have an oral 
sensitivity to tomatoes or peaches (a tingling or buzzing sensation) 
have experienced the same symptoms with oral cannabis products.

A skin or blood test would be very useful in knowing for certain, but 
it's not always necessary to know for certain in order to treat an allergy.

Dr. David Engler, of Houston Allergy & Asthma Clinic in Houston, 
Texas, said that in the successful treatment of an unusual case of 
cannabis-related anaphylaxis in a police detective, he was unable to 
confirm with a clinical test that pot was indeed causing the 
reaction. That reaction was unusually severe, he said, and the case very rare.

"To my knowledge a series of one," he said of his patient.

There are five grades of anaphylaxis, grade 5 being death, and 
Engler's patient would jump right to stage 4 within seconds of casual 
exposure to cannabis smoke or pollen. Grade 4 includes a drop in 
blood pressure and a loss of consciousness, and without immediate 
intervention, can kill a person.

In an interview during the home leg of his daily commute, Engler said 
on speakerphone that the detective sometimes encountered pot during 
the course of her job, and after a series of attempts with other 
drugs to "teflon-coat" her against casual exposure, they settled on 
one drug that has succeeded in removing the dire threat to her life. 
A harbinger symptom, a specific warning sign that an anaphylactic 
attack is about to happen, still appears for her when pollen or smoke 
are present, but with the treatment, she doesn't have to go quickly 
for her epinephrine auto-injectors.

During his effort to treat the detective, Engler called research 
clinics to see about a blood test to confirm a cannabis allergy, but 
came up short, and he finally happened upon a procedure that another 
clinic used to create a skin test. The method involved grinding up 
buds, and his office manager called the DEA for permission. He said 
the agency denied the request and warned of consequences if he 
created the test without permission, saying they had his name now.

"So," Engler said, "we're making a bit of an assumption that she's 
allergic, but you know, I'm also making an assumption that gravity 
works because my car is still on the road."

Treatments and the future

So far, understanding is incomplete, but the indications are that 
cannabis allergies are very similar to other allergies, and standard 
treatments and tests may eventually become widespread, but work is 
still being done. And there is reason to believe that cases of 
cannabis allergy are being more frequently reported since prohibition 
has waned in some states. Although, that's not the same as saying 
such allergies are occurring more frequently since the advent of 
legalization, that possibility does exist.

Because of the checkered illegality of the substance across the 
country, cases of cannabis allergy still aren't commonly seen, a fact 
expected to change with more states allowing adult use. And because 
of the continued illegality at the federal level, research 
opportunities are limited, although policy softened slightly last 
month. Both of those factors were obstacles to further understanding 
that physicians pointed to in our conversations.

As for treatments, Dr. Lieberman, explainer for the AAAAI, wrote in a 
column that there is some indication that sensitization treatments (a 
process of injections) could help people overcome marijuana allergies 
as they have in the case of other allergies, but that it would 
require further study.

Dr. Engler said of the current status of cannabis research, "There 
are lots of unanswered questions, but I don't think the answer to 
those questions is continued prohibition. My patient is scared to 
death it'll be legalized in Texas, but I think that's about 20 years away."

Understanding is increasing, though, even among experts. Engler said 
that his patient was turned away many times when she first sought 
treatment, with clinics saying that she was told, "That allergy 
doesn't exist," or "We don't treat those things."

But, as many are learning, yes, it is possible to be allergic to 
cannabis, from mildly to severely. But it's more likely that Chris's 
symptoms are being caused by airborne allergens than by 
cannabis-infused edibles.
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MAP posted-by: Jay Bergstrom