New definition for 'garlic breath'
Garlic-induced occupational allergy is a relatively rare problem but seems to affect young people with pollen allergy, and sensitization to other members of the Liliaceae family also is common in these patients. Researchers from Madrid, Spain, suggest that occupational health professionals watch for symptoms of occupational asthma in workers exposed to garlic dust, as well as onions, leeks, and asparagus.1
Garlic is known to be a potent contact allergen, causing contact dermatitis among professional cooks or others handling garlic bulbs, but it has not previously been considered a common cause of immunoglobulin E-mediated disease. In this report, the authors discuss the cases of 12 patients with rhinitis and asthma in whom garlic occupational allergy was suspected. Nine patients worked as harvesters in garlic fields, 10 worked in garlic storage facilities, and five worked in spice-manufacturing factories.
Skin-prick tests with commercial extracts of garlic, onion, leek, and asparagus were negative in all but one patient who was extremely sensitive to garlic. However, the skin-test responses using garlic dust and fresh bulbs were positive in seven of the 12 patients. Skin-test responses were positive in four patients with onion and asparagus and in three patients with leek. Skin-prick tests for commercial extracts of onion, leek, and asparagus were all negative.
"The diagnosis of garlic-induced occupational allergy should be based on a detailed medical history, on in vivo and in vitro demonstration of specific IgE, and on challenge test results," the researchers write.
"In our experience, commercial garlic extracts are not useful. Positive [skin-prick test] responses to appropriate garlic extracts, dust, or fresh samples seem much more specific and correlate with the presence of specific IgE. However, the gold standard for specific diagnosis remains the inhalation provocation test."
Reference
1. Anibarro B, Fontela JL, De La Hoz F. Occupational asthma induced by garlic dust. J Allergy Clin Immunol 1997; 100:734-738.
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