We contacted Sami Bahna, MD, DrPH and his comments are below.
This young child’s medical history is convincing of multiple IgE-mediated reactions to certain types of peppers or “spice mixture”. Published studies on diagnostic tests for spices by SPT and sIgE are very limited and, in general, showed low reliability. Verification requires a cautious titrated challenge under supervision. Non-IgE mediated reactions are primarily type IV (contact dermatitis). More info is in a review article (Ann Allergy Ashma Immunol 2011;107:191).
For this youngster, in addition to strict avoidance, I would prescribe epinephrine auto-injector –overusing it is better than not, particularly since her latest reaction was severer than before. Outgrowing this allergy is very likely though may take several years. Many allergens in spices are resistant to processing (heat, grinding, drying, freezing, pickling).
I hope this information is of help to you and your patient.
All my best.
Dennis K. Ledford, MD, FAAAAI