Q:

6/12/2014
51 year-old lady drank only Trader Joe's Oraganic Chamomile tea (had been drinking for several months as sleep aid) and 1/2 hr later developed generalized hives. She slowly improved with 2 Benadryl. History of asthma since child, OAS with melons, pears & avocado. Has tree nut and pine nut allergy. Hives with Ampicillin and face/throat swelling with ASA. Have you heard of this tea allergy and any way to test? Make a potion and do prick?

A:

Thank you for your inquiry.

Anaphylaxis to chamomile tea is a well-recognized entity and appears to be IgE-mediated. The abstracts copied below will allow you to access materials and methods for skin testing.

Skin testing can and should be done in this situation. It is also important to note the potential crossreactivity between chamomile and Artemisia vulgaris and potentially other allergens.

Thank you again for your inquiry and we hope this response is helpful to you.

J Allergy Clin Immunol. 1989 Sep;84(3):353-8.
Anaphylactic reaction after the ingestion of chamomile tea: a study of cross-reactivity with other composite pollens.
Subiza J1, Subiza JL, Hinojosa M, Garcia R, Jerez M, Valdivieso R, Subiza E.
Author information
1Centro de Alergia e Inmunologic Clínica, General Pardiñas, Madrid, Spain.
Abstract
We report a case of an 8-year-old atopic boy in whom ingestion of a chamomile-tea infusion precipitated a severe anaphylactic reaction. The patient suffers from hay fever and bronchial asthma caused by a variety of pollens (grass, olive, and mugwort). This severe reaction was developed after his first ingestion of chamomile tea. Studies revealed the presence of immediate skin test reactivity and a positive passive transfer test to chamomile-tea extract. Moreover, both specific antichamomile-tea extract and anti-Matricaria chamomilla-pollen extract IgE antibodies were detected by an ELISA technique. Cross-reactivity among chamomile-tea extract and the pollens of Matricaria chamomilla, Ambrosia trifida (giant ragweed), and Artemisia vulgaris (mugwort), was demonstrated by an ELISA-inhibition study. These findings suggest a type I IgE-mediated immunologic mechanism as being responsible for the patient's anaphylactic symptoms and also suggest that the patient cross-reacted the pollens of Matricaria chamomilla contained in the chamomile tea because he was previously sensitized to Artemisia pollen.

Clin Exp Allergy. 2000 Oct;30(10):1436-43.
Anaphylaxis to camomile: clinical features and allergen cross-reactivity.
Reider N1, Sepp N, Fritsch P, Weinlich G, Jensen-Jarolim E.
Author information
1Department of Dermatology, University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Abstract
Background: Medicinal remedies of plant origin became very popular in recent years, and allergic reactions to these are on the rise, accordingly. Camomile has been reported as a potential trigger of severe anaphylaxis. The allergens responsible for camomile allergy have not been characterized as yet.
Objective: The present study aims at reviewing the clinical symptomatology of immediate-type reactions in a series of patients sensitized to camomile and at characterizing the responsible allergens.
Methods: Fourteen patients with a history of allergy either to camomile or to spices or weeds, and a positive skin prick test/RAST to camomile were investigated for related allergic reactions to food, pollen and others. IgE-binding patterns were determined by immunoblotting, inhibition tests and deglycosylation experiments.
Results: Ten of 14 patients had a clinical history of immediate-type reactions to camomile, in some cases life threatening. Eleven subjects were also sensitized to mugwort in prick or RAST, eight to birch tree pollen. Using a polyclonal rabbit anti-Bet v 1 antibody, a homologue of the major birch pollen allergen Bet v 1 was detected in two camomile blots. In four cases a group of higher molecular weight allergens (23-50 kDa) showed IgE-binding to camomile. All allergens proved heat stable. Binding was inhibited in variable degrees by extracts from celery roots, anize seeds and pollen from mugwort, birch and timothy grass. Deglycosylation experiments proved the presence of carbohydrate determinants in camomile which were not responsible for IgE-binding, though. Profilins (Bet v 2) were not detected in our camomile extracts.
Conclusion: Incidence and risk of type I allergy to camomile may be underestimated. Concurrent sensitization to mugwort and birch pollen is not infrequent. Bet v 1 and noncarbohydrate higher molecular weight proteins were found to be eliciting allergens and are responsible for cross-reactivity with other foods and pollen.

J Investig Allergol Clin Immunol. 2001;11(2):118-22.
Clinical cross-reactivity between Artemisia vulgaris and Matricaria chamomilla (chamomile).
de la Torre Morín F1, Sánchez Machín I, García Robaina JC, Fernández-Caldas E, Sánchez Triviño M.
Author information
1Hospital Nuestra Señora de la Candelaria, Tenerife, Canary Islands, Spain.
Abstract
Artemisia vulgaris is a common weed and an important source of allergens on the subtropical island of Tenerife, Canary Islands, Spain. It pollinates mainly from July to September, although, due to some local climatic conditions, it may flower throughout the year. Cross-reactivity with hazelnut, kiwi, birch, several Compositae (Ambrosia, Chrysanthemum, Matricaria, Solidago) and grass allergens has been suggested. Few studies have addressed the issue of in vivo cross-reactivity between A. vulgaris and Matricaria chamomilla. The objective of this study was to perform conjunctival and bronchial challenges with A. vulgaris and M. chamomilla and oral challenge with chamomile in 24 patients with asthma and/or rhinitis sensitized primarily to A. vulgaris. Skin prick tests with M. chamomilla were positive in 21 patients. Eighteen patients had a positive conjunctival provocation test with a A. vulgaris pollen extract and 13 patients had a positive conjunctival provocation test with a M. chamomilla pollen extract. Bronchial provocation tests with A. vulgaris were positive in 15 patients and with M. chamomilla pollen in another 16 individuals. Oral provocation tests, conducted with a commercial chamomile infusion were positive in 13 patients. Nine of these individuals were skin test positive to food allergens and 17 to others pollens of the Compositae family. This study confirms a high degree of in vivo cross-reactivity between A. vulgaris and M. chamomilla. Sensitization to A. vulgaris seems to be a primary risk factor for experiencing symptoms after the ingestion of chamomile infusions. Based on the results of bronchial provocation tests, M. chamomilla pollen could be a relevant inhalant allergen.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology