Cannabis allergy in a child with asthma chronically exposed to marijuana

Secondhand smoke exposure and asthma status among adolescents: Findings from the 2019-2020 California Student Tobacco Survey

Background and objectives

Secondhand tobacco smoke is associated with worsening asthma symptoms among children. However, the relationship between secondhand marijuana smoke and asthma symptoms among youth has not been examined. This study compares the prevalence of secondhand tobacco and marijuana smoke exposure, overall and by asthma status, among middle and high school students.

Methods

The study assessed participants of the 2019-2020 California Student Tobacco Survey: a large, cross-sectional random sample of 8th, 10th, and 12th graders (N = 158,937). Descriptive analyses examined exposure to combustible tobacco and marijuana secondhand smoke by students' asthma status and sociodemographic characteristics.

Results

More students with asthma were exposed to combustible tobacco secondhand smoke (13.4 %) and marijuana secondhand smoke (12.0 %) than students without asthma (10.9 % and 9.3 %, respectively). The prevalence of secondhand marijuana smoke exposure was higher among 12th grade students (12.2 %) while the prevalence of secondhand tobacco smoke exposure was higher among 8th grade students (13.4 %) and those who lived in rural locations (15.4 %).

Conclusions

California students are exposed to marijuana secondhand smoke at similar proportions to combustible tobacco secondhand smoke and more students with asthma are exposed to marijuana secondhand smoke. These results expand the public health issue of secondhand smoke exposure among children with asthma by highlighting the need to examine marijuana secondhand smoke. Given the rapid shift in marijuana laws across the US, exposure to secondhand marijuana smoke is likely to increase. Therefore, vulnerable populations, such as children with asthma, should be prioritized for interventions that aim to alleviate secondhand marijuana exposure.

IgE-Mediated Allergy and Asymptomatic Sensitization to Cannabis Allergens-Review of Current Knowledge and Presentation of Six Cases

Cannabis allergy is a relatively new phenomenon described in the 1970s. Its increased frequency has been observed over the last years due to the increasing therapeutic and recreational use of cannabis-based products. Sensitization possibly leading to allergy symptoms can occur not only through the smoking of cannabis, but also through ingestion, the inhalation of pollen, or direct contact. The severity of symptoms varies from benign pruritus to anaphylaxis. There is scant information available to support clinicians throughout the entire therapeutic process, starting from diagnosis and ending in treatment. In this review, we present six cases of patients in whom molecular in vitro testing revealed sensitization to cannabis extract and/or cannabis-derived nsLTP molecules (Can s 3). Based on these cases, we raise important questions regarding this topic. The article discusses current proposals and highlights the importance of further research not only on cannabis allergy but also on asymptomatic sensitization to cannabis allergens, which may be ascertained in some percentage of the population.

[Inhaled marijuana and the lung, a toxic cocktail?]

Unlike the well-documented effects of tobacco smoke on the lung, the effects of cannabis smoke remain controversial, the main bias consisting in co-consumption of tobacco. That said, the composition of joint smoke is close to that of cigarettes, containing many compounds that are carcinogenic and/or alter the respiratory epithelium. Confirmed respiratory effects in chronic cannabis smokers include aggravated chronic bronchitis symptoms, a cumulative effect with tobacco on COPD and emphysema occurrence, an increased risk of bullous emphysema, and pneumothorax with heightened risk of recurrence after pleural symphysis. Recent prospective studies have shown a negative impact on lung function, with not only damage to the airways, but also DLCO alteration and an accelerated drop in FEV1. Finally, cannabis smoking is very common among young patients with lung cancer. Its consumption could lead to a different lung cancer profile, potentially more undifferentiated and less accessible to targeted therapy. Questioning about cannabis consumption must be systematic and targeted medical care should be offered.

Cannabis-related allergies: An international overview and consensus recommendations

Cannabis is the most widely used recreational drug in the world. Cannabis sativa and Cannabis indica have been selectively bred to develop their psychoactive properties. The increasing use in many countries has been accelerated by the COVID-19 pandemic. Cannabis can provoke both type 1 and type 4 allergic reactions. Officially recognized allergens include a pathogenesis-related class 10 allergen, profilin, and a nonspecific lipid transfer protein. Other allergens may also be relevant, and recognition of allergens may vary between countries and continents. Cannabis also has the potential to provoke allergic cross-reactions to plant foods. Since cannabis is an illegal substance in many countries, research has been hampered, leading to challenges in diagnosis since no commercial extracts are available for testing. Even in countries such as Canada, where cannabis is legalized, diagnosis may rely solely on the purchase of cannabis for prick-to-prick skin tests. Management consists of avoidance, with legal issues hindering the development of other treatments such as immunotherapy. Education of healthcare professionals is similarly lacking. This review aimed to summarize the current status of cannabis allergy and proposes recommendations for the future management of this global issue.

Inhaled Marijuana and the Lung

Although vaping has recently increased as a mode of inhaling marijuana and has been associated with numerous and sometimes fatal cases of acute severe lung injury, smoking remains the most common method of inhaling marijuana and has been studied more extensively. Smoking marijuana has been shown to produce modest but significant short-term bronchodilation both in healthy subjects and those with asthma. Long-term effects of habitual marijuana smoking include the following: 1) symptoms of chronic bronchitis (increased cough, sputum production and wheezing); 2) modest effects on lung function in cross-sectional studies (no significant decrease in forced expired volume in 1 second [FEV₁) but mild reductions in FEV₁/forced vital capacity ratio [FEV₁/FVC], an increase in FVC and other lung volumes, reductions in specific airway conductance, and variable effects of maximal mid-expiratory flow rates and diffusing capacity; and 3) variable effects on age-related decline in FEV1 in longitudinal studies. Most cohort and case-control studies have failed to show that marijuana smoking is a significant risk-factor for lung cancer despite the presence of pro-carcinogenic components in marijuana smoke, although further study is warranted. The question whether marijuana smoking is associated with asthma is unclear and requires further investigation. Although delta-9 tetrahydrocannabinol (THC), the principal psychoactive component of marijuana, has immunomodulatory properties that hypothetically could increase the risk of pneumonia, the few available studies in marijuana smokers have failed to find an increased risk of pneumonia in immunocompetent users, although effects in immunosuppressed individuals have been variable.