Identification of carmine allergens among three carmine allergy patients

A Case of Fish Sausage Anaphylaxis Induced by Epicutaneous Sensitization to Carmine Contained in Eyeshadows: The Effect of Chelation on Carmine Allergy

Carmine is an aluminium and/or calcium-chelated complex form of carminic acid (CA), which is derived from the Dactylopius coccus extract (cochineal), and is globally used as a red-colourant in foods and cosmetics. Although several allergens in carmine allergies, such as CC38K, have been reported, it remains unknown whether chelation affects the allergenicity of carmine. We report a case of Japanese fish sausage (Gyoniku Sausage) anaphylaxis induced by epicutaneous sensitization to carmine contained in eyeshadows. In addition, we report on the effect of chelation on carmine allergy. A 32-year-old woman had experienced itching, wheals, and swelling of her eyelids immediately after applying pink eyeshadows, which contained carmine, on several occasions for 3 years. Two months ago, she developed itching, wheals, and swelling on her whole body, especially her eyelids, and dyspnea immediately after ingesting fried pink fish sausages, which contained cochineal. In skin prick tests (SPTs) with all ingredients ingested in the two episodes of anaphylaxis, only fish sausage was positive. SPT was also positive for carmine. In IgE-immunoblotting using the eyeshadow and fish sausage, the patient serum IgE was bound to three protein bands at approximately 86, 114, and 130 kDa. In addition, IgE-immunoblotting using the carmine showed a broad band at 86-130 kDa, which were consistent with those using the eyeshadow and fish sausage, whereas there is no band using CA. Interestingly, the protein bands using the eyeshadow and carmine were diminished by preincubation in the presence of ethylenediaminetetraacetic acid (EDTA) as a chelating agent. The results indicated that the causative allergens of carmine contained in the eyeshadows could be dechelated by EDTA, reducing its allergenicity. In conclusion, carmine contained in cosmetics can cause epicutaneous sensitisation and consequently can induce food anaphylaxis. To prevent sensitisation in carmine allergy, the effect of chelation on allergenicity of carmine should be considered.

A Review of the Chemistry and Biological Activities of Natural Colorants, Dyes, and Pigments: Challenges, and Opportunities for Food, Cosmetics, and Pharmaceutical Application

Natural pigments are important sources for the screening of bioactive lead compounds. This article reviewed the chemistry and therapeutic potentials of over 570 colored molecules from plants, fungi, bacteria, insects, algae, and marine sources. Moreover, related biological activities, advanced extraction, and identification approaches were reviewed. A variety of biological activities, including cytotoxicity against cancer cells, antioxidant, anti-inflammatory, wound healing, anti-microbial, antiviral, and anti-protozoal activities, have been reported for different pigments. Considering their structural backbone, they were classified as naphthoquinones, carotenoids, flavonoids, xanthones, anthocyanins, benzotropolones, alkaloids, terpenoids, isoprenoids, and non-isoprenoids. Alkaloid pigments were mostly isolated from bacteria and marine sources, while flavonoids were mostly found in plants and mushrooms. Colored quinones and xanthones were mostly extracted from plants and fungi, while colored polyketides and terpenoids are often found in marine sources and fungi. Carotenoids are mostly distributed among bacteria, followed by fungi and plants. The pigments isolated from insects have different structures, but among them, carotenoids and quinone/xanthone are the most important. Considering good manufacturing practices, the current permitted natural colorants are: Carotenoids (canthaxanthin, β-carotene, β-apo-8'-carotenal, annatto, astaxanthin) and their sources, lycopene, anthocyanins, betanin, chlorophyllins, spirulina extract, carmine and cochineal extract, henna, riboflavin, pyrogallol, logwood extract, guaiazulene, turmeric, and soy leghemoglobin.

Dyes Used in Processed Meat Products in the Polish Market, and Their Possible Risks and Benefits for Consumer Health

Manufacturers are obliged to label processed meat products with information concerning the additives used and nutritional values. The aim of the study was to identify the dyes most frequently used in processed meat, evaluate their influence on specific food qualities, assess whether their use was correct and review their effect on health. The analysis was based on information on the labels and images of processed meat, and used a generalised linear model with a binary dependent variable. The risks and benefits for human health were defined based on the available literature. Twelve dyes were found to be used in the manufacture of processed meat. Carmine was found in 183 of 273 (67.03%) evaluated assortments containing dyes. The occurrence of water, flavourings and high fat and carbohydrate contents increased the chances that a dye would be present in a particular product. Unauthorised use of food additives was found in 20 products, with smoked meat products demonstrating the highest number of non-compliances. In general, the dyes used with food are considered safe; however, reservations are associated with the use of E150C and E150D caramels due to their potential carcinogenic effect, and carmine and annatto due to their allergic effects.

Progress and Prospective of the Industrial Development and Applications of Eco-Friendly Colorants: An Insight into Environmental Impact and Sustainability Issues

Color is the prime feature directly associated with the consumer's attraction and choice of their food. The flavor, safety, and nutritional value of any food product are directly associated with the food color. Natural and synthetic colorants (dyes and pigments) have diversified applications in various sectors such as food, feed, pharmaceutical, textiles, cosmetics, and others. Concerning the food industry, different types of natural and synthetic colorants are available in the market. Synthetic food colorants have gained popularity as they are highly stable and cheaply available. Consumers worldwide prefer delightful foodstuffs but are more concerned about the safety of the food. After its disposal, the colloidal particles present in the synthetic colorants do not allow sunlight to penetrate aquatic bodies. This causes a foul smell and turbidity formation and gives a bad appearance. Furthermore, different studies carried out previously have presented the toxicological, carcinogenic effects, hypersensitivity reactions, and behavioral changes linked to the usage of synthetic colorants. Natural food colorings, however, have nutraceutical qualities that are valuable to human health such as curcumin extracted from turmeric and beta-carotene extracted from carrots. In addition, natural colorants have beneficial properties such as excellent antioxidant properties, antimutagenic, anti-inflammatory, antineoplastic, and antiarthritic effects. This review summarizes the sources of natural and synthetic colorants, their production rate, demand, extraction, and characterization of food colorants, their industrial applications, environmental impact, challenges in the sustainable utilization of natural colorants, and their prospects.

Recent advantages in electrochemical monitoring for the analysis of amaranth and carminic acid food colors

This study provides a comprehensive review of the latest developments in the electrochemical impressions of the important dyestuffs including amaranth and carminic acid. Food colors are organic substances that have important effects on human health and food safety. While these substances do not pose a problem when used in the daily intake (ADI) amounts, they harm human health when consumed excessively. Amaranth and carminic acid are synthetic and natural food colors ingredients, respectively. Analysis of these substances in food, pharmaceutical, cosmetic and textile samples is extremely important because of their genotoxicity, cytostatic and cytotoxic effects. Electroanalytical methods, which have great advantages over traditional analytical methods, shed light on the scientific world. Electrochemical monitoring modules, which are fast, simple, accurate, reliable, and highly selective, are promising for the determination of both substances. Until now, amaranth and carminic acid food determinations have been carried out successfully with electrochemical monitoring techniques in many numbers in the literature. Voltammetric techniques are the most widely used among these electroanalytical methods. In particular, square wave and differential pulse voltammetric techniques, which have extraordinary properties, have been heavily preferred. Limits of detection (LOD) comparable to the standard analytical method have been achieved using these methods, which have very quick analysis durations, high precision and accuracy, do not require long preprocessing, and have great selectivity. In addition, more sensitive and selective analyses of amaranth and carminic acid in natural samples were carried out with numerous indicator electrodes. The merits of powerful electrochemical monitoring studies for the determination of both food colors during the last decade are presented in this study. Moreover, parameters such as analytical applications, detection limits, electrochemical methods, selectivity, working electrodes, and working ranges are summarized in detail.

Adverse reactions to food additives

Food additives are naturally occurring or synthetic substances that are added to food to modify the color, taste, texture, stability, or other characteristics of foods. These additives are ubiquitous in the food that we consume on a daily basis and, therefore, have been the subject of much scrutiny about possible reactions. Despite these concerns, the overall prevalence of food additive reactions is 1-2%, with a minority of the wide variety of symptoms attributed to food-additive exposure being reproduced by double-blind placebo controlled challenges. Reactions can be broadly classified into either immunoglobulin E (IgE)- and non-IgE-mediated reactions, with natural additives accounting for most IgE-mediated reactions, and both natural and synthetic additives being implicated in the non-IgE-mediated reactions. Reactions that include asthma exacerbations, urticaria and/or angioedema, or anaphylaxis with ingestion of a food additive are most deserving of further allergy evaluation. In this article, we discussed the different types of adverse reactions that have been described to various food additives. We also reviewed the specifics of how to evaluate and diagnose a food additive allergy in a clinic setting.

Patch Testing With Carmine 2.5% in Petrolatum by the North American Contact Dermatitis Group, 2011-2012

BACKGROUND

Carmine is a natural red dye that may cause allergic contact dermatitis.

OBJECTIVE

The aim of this study was to analyze patch test reactions to carmine (2.5% in petrolatum) and characterize carmine-positive patients.

METHODS

This study conducted a retrospective analysis of North American Contact Dermatitis Group data compiled between 2011 and 2012.

RESULTS

Of 4240 patients patch tested to carmine, 132 (3.1%) had reactions with a final interpretation of "allergic" (positive). Carmine-positive patients were significantly more likely to be female (77.7% vs 68.3%; P = 0.0237) and have a final primary diagnosis of allergic contact dermatitis (74.8% vs 47.2%; P < 0.0001). As compared with carmine-negative patients, carmine-positive patients were significantly more likely to have involvement of all facial sites combined (48.1% vs 29.9%; P < 0.0001) and the lips (7.6% vs 3.6%; P = 0.0166). At final reading, most carmine reactions were weak (+; 64.9%). Approximately half (53.4%) were currently clinically relevant; identified sources were primarily personal care products (77.1%), especially makeup (31.4%) and lip products (8.6%).

CONCLUSIONS

Weak patch test reactions to carmine should be interpreted with caution. Allergic contact dermatitis to carmine should be suspected in women with facial and/or lip dermatitis, especially those using carmine-containing cosmetics.

Insects as human food; from farm to fork

Over the course of the last few years, the consumption of insects, known as entomophagy, has sparked increasing interest amongst scientists and environmentalists as a potential solution to the inevitable global food security and sustainability issues humans will be facing in the coming years. Despite the fact that insects have been an integral part of over 2 billion people's diet worldwide, the concept of eating insects is still new to Western culture. As a result, there are many unknowns regarding insects as a food source, and this has led to a number of studies and investigations being done in recent years to create more knowledge and awareness around this new concept in the food industry. This review discusses some of the key topics and new developments published over recent years, such as the nutritional benefits, food safety concerns, functional properties, potential product concepts and the current ideas and attitudes towards insects as a food source in Western culture. © 2017 Society of Chemical Industry.

Entomophagy: Nutritional, ecological, safety and legislation aspects

Globally, there is a need to seek alternative sources of protein in addition to meat. This has led to considerable interest in edible insects. Such insects form part of cultures and diets in many Asian and African countries, and are an excellent source of essential nutrients, minerals, vitamins and proteins. Furthermore, they have been reported to be sustainable. The ecological importance of insects is related to their short life cycles when reared and farmed. This makes them ideal in mitigating greenhouse gas emissions, cutting land uses and polluted water, and reducing environmental contamination. However, the use of edible insects as food in Europe is minimal. To ensure safety of insects when eaten as food, considerations should be made on: microbiological contamination; toxicological hazards, e.g. chemical hazards and antinutrients; allergenicity issues that are related to different exposures, including injection, ingestion, inhalation and skin contact. In this review, we summarize the nutritional and sustainable values of edible insects, look at safety and legislative measures and we finally discuss future issues.

Hypersensitivity reactions to food and drug additives: problem or myth?

BACKGROUND AND AIM OF THE WORK

The possibility of an allergic reaction or an intolerance to additives is frequently suspected by parents, especially for chronic illness with frequent exacerbations such as atopic dermatitis or chronic urticaria. For more than 50 years, potential adverse reactions to additives have been suggested, but to date data are conflicting. The purpose of this article is to provide the clinicians with general information about additives and adverse reactions to them and to suggest a practical approach to children suspected to have reactions to food additives.

METHODS

We performed an extensive research on all English-language Medline articles, case reports and reviews published online until December 2018. Used search terms were: food additives, food dye, adverse reactions, food allergy, food hypersensitivity, intolerance, drugs, children.

RESULTS

There are only few case reports of adverse reactions in childhood with a clear involvement of additives. In this review article we reported the associations between additives and adverse reactions described in literature, in order to inform the pediatrician about the potential clinical manifestations.

CONCLUSIONS

Prior to suspect an adverse reaction to additives, it is important to rule out other possible causes: the diagnostic process is complicated and rarely conclusive. The gold standard is the double-blind placebo controlled oral challenge after an exclusion diet.

Contact Dermatitis to Carmine

: Carmine is a widely used "natural" food additive that has been reported to provoke both an immediate hypersensitivity and a delayed systemic response with cutaneous expression. Systemic contact dermatitis describes the hypersensitivity reaction following systemic re-exposure of the inciting allergen in previously sensitized individuals. In individuals with recalcitrant dermatitis and a positive carmine intolerance history and/or patch test, it is important to consider a trial topical and dietary elimination of carmine-associated products and foods.

Cochineal dye-induced immediate allergy: Review of Japanese cases and proposed new diagnostic chart

BACKGROUND

Cochineal dye is used worldwide as a red coloring in foods, drinks, cosmetics, quasi-drugs, and drugs. The main component of the red color is carminic acid (CA). Carmine is an aluminum- or calcium-chelated product of CA. CA and carmine usually contain contaminating proteins, including a 38-kDa protein thought to be the primary allergen. Severe allergic reactions manifest as anaphylaxis. The aim of this study was to review all Japanese reported cases and propose useful diagnostic chart.

METHODS

All reported Japanese cases of cochineal dye-induced immediate allergy were reviewed, and newly registered cases were examined by skin prick test (SPT) with cochineal extract (CE) and measurement of CE and carmine-specific serum IgE test. Two-dimensional (2D) western blotting using patient serum was conducted to identify the antigen.

RESULTS

Twenty-two Japanese cases have been reported. SPT and the level of specific IgE test indicated that six cases should be newly registered as cochineal dye allergy. All cases were adult females, and all cases except three involved anaphylaxis; 13 cases involved past history of local symptoms associated with cosmetics use. Japanese strawberry juice and fish-meat sausage, and European processed foods (especially macarons made in France) and drinks were recent major sources of allergen. 2D western blotting showed that patient IgE reacted to the 38-kDa protein and other proteins. Serum from healthy controls also weakly reacted with these proteins.

CONCLUSIONS

SPT with CE and determination of the level of CE and carmine-specific IgE test are useful methods for the diagnosis of cochineal dye allergy.

Insect (food) allergy and allergens

Insects represent an alternative for meat and fish in satisfying the increasing demand for sustainable sources of nutrition. Approximately two billion people globally consume insects. They are particularly popular in Asia, Latin America, and Africa. Most research on insect allergy has focussed on occupational or inhalation allergy. Research on insect food safety, including allergenicity, is therefore of great importance. The objective of this review is to provide an overview of cases reporting allergy following insect ingestion, studies on food allergy to insects, proteins involved in insect allergy including cross-reactive proteins, and the possibility to alter the allergenic potential of insects by food processing and digestion. Food allergy to insects has been described for silkworm, mealworm, caterpillars, Bruchus lentis, sago worm, locust, grasshopper, cicada, bee, Clanis bilineata, and the food additive carmine, which is derived from female Dactylopius coccus insects. For cockroaches, which are also edible insects, only studies on inhalation allergy have been described. Various insect allergens have been identified including tropomyosin and arginine kinase, which are both pan-allergens known for their cross-reactivity with homologous proteins in crustaceans and house dust mite. Cross-reactivity and/or co-sensitization of insect tropomyosin and arginine kinase has been demonstrated in house dust mite and seafood (e.g. prawn, shrimp) allergic patients. In addition, many other (allergenic) species (various non-edible insects, arachnids, mites, seafoods, mammals, nematoda, trematoda, plants, and fungi) have been identified with sequence alignment analysis to show potential cross-reactivity with allergens of edible insects. It was also shown that thermal processing and digestion did not eliminate insect protein allergenicity. Although purified natural allergens are scarce and yields are low, recombinant allergens from cockroach, silkworm, and Indian mealmoth are readily available, giving opportunities for future research on diagnostic allergy tests and vaccine candidates.

Safety aspects of the production of foods and food ingredients from insects

At present, insects are rarely used by the European food industry, but they are a subject of growing interest as an alternative source of raw materials. The risks associated with the use of insects in the production of foods and food ingredients have not been sufficiently investigated. There is a lack of scientifically based knowledge of insect processing to ensure food safety, especially when these processes are carried out on an industrial scale. This review focuses on the safety aspects that need to be considered regarding the fractionation of insects for the production of foods and food ingredients.

The Determination of Food Dyes in Vitamins by RP-HPLC

Reversed-phase high performance liquid chromatography (RP-HPLC) for the determination of five synthetic food dyes (Quinoline Yellow E104, Sunset Yellow E110, Ponceau 4R E124, Tartrazine E102 and Carmine E120) in vitamins was used. The dyes were analyzed within 10 min using a column with stationary phase C 18 (250 mm × 4.6 mm, 5 μm) at 40 °C with isocratic elution, and the mobile phase contained acetonitrile and a mixture of CH₃COONa:CH₃OH (85:15, v/v) in a ratio of 10:90 (v/v) for yellow-colored capsules and 20:80 (v/v) for red-colored capsules, respectively. A diode-array detector was used to monitor the dyes between 190 and 800 nm. It was established that the analyzed samples contained synthetic dyes in a concentration range from 79.5 ± 0.01 μg/capsule of Ponceau 4R, E124 to 524 ± 0.01 μg/capsule of Tartrazine, E102. The obtained results were compared with existing acceptable daily intakes (ADIs) for individual dyes. This paper provides information about the content of dyes in samples of vitamins. This information is not generally available to consumers.

Is Patch Testing with Food Additives Useful in Children with Atopic Eczema?

BACKGROUND

Atopy patch testing is a useful way to determine delayed-type hypersensitivity reactions to foods and aeroallergens. Although food additives have been accused of worsening atopic eczema symptoms, according to recent studies the role of food additives in atopic eczema remains unclear. The purpose of our study was to investigate food additive hypersensitivity in a group of children with atopic eczema by using standardized atopy patch testing and to determine the role of food additive hypersensitivity in atopic eczema.

METHODS

Thirty-four children with atopic eczema and 33 healthy children were enrolled in the study. Children who consumed foods containing additives and did not use either antihistamines or local or systemic corticosteroids for at least 7 days prior to admission were enrolled in the study. All children were subjected to atopy patch testing and after 48 and 72 hours their skin reactions were evaluated by using the guidelines.

RESULTS

Positive atopy patch test results were significantly higher in the atopic eczema group. Forty-one percent of the atopic eczema group (n = 14) and 15.2% (n = 5) of the control group had positive atopy patch test results with food additives (p = 0.036) (estimated relative risk 1.68, case odds 0.7, control odds 0.17). Carmine hypersensitivity and the consumption of foods containing carmine, such as gumdrops, salami, and sausage, were significantly higher in the children with atopic eczema.

CONCLUSION

This is the first study investigating hypersensitivity to food additives in children with atopic eczema. Our results indicate that carmine may play a role in atopic eczema.

Simultaneous Determination of Acetaminophen and Synthetic Color(s) by Derivative Spectroscopy in Syrup Formulations and Validation by HPLC: Exposure Risk of Colors to Children

Color additives are used in pediatric syrup formulations as an excipient; though not pre-requisite, but pediatric syrup formulations are normally colored. An attempt has been made to measure simultaneously the single drug, acetaminophen (AT), along with the colors, carmoisine (CA), erythrosine (ET), and sunset yellow FCF (SSY) added in it by three derivative spectroscopy methods namely, 1st order, ratio, and differential derivative methods. Moreover, evaluation has been made for the exposure assessment of the colors added as excipient because some colors have been reported to cause allergic reactions and hypersensitivity in children. The present methods provide simple, accurate, and reproducible quantitative determination of the drug, AT, along with the color in synthetic mixtures and commercial drug formulations without any interference. The limit of detection varied from 0.0001-0.31 μg/ml while limit of quantification ranged from 0.002-1.04 μg/ml in all the three methods. The calibration curve of all the three derivative methods exhibited good linear relationship with excellent regression coefficients (0.9986-1.000). Both intra-day and inter-day precisions showed %RSD value less than 2% while the percentage recovery was found between 96.8-103.8%. The sensitivity of the proposed methods is almost comparable to HPLC and thus, can be used for determination of drug AT, and color simultaneously in pharmaceutical formulation on routine basis. The present methods also showed that colors like SSY and ET are saturating more than 50% of acceptable daily intake (ADI) value which is alarming and needs to be considered for modification by regulatory authorities to safeguard the health of children.

Allergic and immunologic reactions to food additives

For centuries, food additives have been used for flavouring, colouring and extension of the useful shelf life of food, as well as the promotion of food safety. During the last 20 years, the studies implicating the additives contained in foods and medicine as a causative factor of allergic reactions have been proliferated considerably. In this review, we aimed to overview all of the food additives which were approved to consume in EU and find out how common and serious allergic reactions come into existence following the consuming of food additives.

Determination of the food dye carmine in milk and candy products by differential pulse polarography

As a basis for the development of a sensitive analytical method for the determination of carmine food dye, a study of the differential pulse polarographic reduction of carminic acid (CA) on a dropping mercury electrode was performed. For the analytical differential pulse polarographic method running at pH 2.0 Britton-Robinson (B-R) buffer solution (peak at -489 mV), the relationship between the peak current and CA concentration was linear in the range of 1 μM to 90 μM with a detection limit of 0.16 μM. The proposed electrochemical procedure was successfully applied to the determination of carmine food dye in spiked commercially available strawberry flavored milk. The method was extended to the determination of CA in candy and results were in agreement with that obtained by a spectrophotometric comparison method. A cyclic voltammogram of CA in 2.0 B-R buffer electrolyte was obtained on the dropping mercury electrode at pH 2.0 during potential scans from 0.00 mV to 1000 mV versus Ag/AgCl. From repetitive cyclic voltammograms, one cathodic peak at -500 mV and three anodic peaks on the reverse scan between approximately -340 mV and -460 mV were recorded. The influences of some other commonly found inorganic and organic salts on the determination of CA were also examined. The sufficiently good recoveries and low standard deviations for the data reflect the high accuracy and precision of the proposed differential pulse polarographic method.

Promoting effects of carminic acid-enriched cochineal extracts on capsular invasive thyroid carcinomas through targeting activation of angiogenesis in rats

Cochineal extracts (CE) is a coccid-derived natural food colorant containing carminic acid (CA) as an active ingredient that potentiates inhibition of tissue proteolysis mediated by activation of plasma hyaluronan-binding protein (PHBP). In our previous study, dietary administered CE (CA: 28.5% in CE) has shown to promote the macroscopic development of capsular invasive carcinomas (CICs) associated with up-regulation of angiogenesis-related genes in an intracapsular invasion model of experimental thyroid cancers using rats. However, the promoting effect of CE could not be confirmed histopathologically. The purpose of the present study was to confirm the promoting effect of CE through direct injections to animals on the development of CICs using this cancer invasion model. One week after initiation with N-bis(hydroxypropyl)nitrosamine, male F344/NSlc rats were administered CA-enriched CE (CA: 52.6% in CE) by intraperitoneal injections every other day (10 mg/kg body weight) during the promotion with 0.15% sulfadimethoxine in the drinking water for 8 weeks. The multiplicities of macroscopical CICs and the mean area of early capsular invasive foci estimated by Tenascin (TN)-C-immunoreactivity in the thyroid significantly increased with CE-treatment, while the number of TN-C-positive foci did not change with CE. Transcript level of Phbp and downstream genes unchanged; however, transcript level of angiogenesis-related genes, i.e, Vegfb and its transcription factor gene, Hif1a, those being downstream of phosphatase and tensin homolog (PTEN)/Akt signaling, up-regulated in the thyroid tissue with CE-administration. These results suggest that CE potentiates promotion activity by facilitating angiogenesis through activation of PTEN/Akt signaling without accompanying modification of PHBP-related proteolysis.

Molecular cloning, expression, and characterization of a major 38-kd cochineal allergen

BACKGROUND

Carmine is a natural red pigment obtained from dried gravid female cochineal insects (Dactylopius coccus or Coccus cacti). There have been several reports of allergies to carmine, but the major allergens responsible have not been identified.

OBJECTIVE

To identify the major allergenic proteins in cochineal.

METHODS

Immunoblots of purified cochineal extract were probed with sera from 3 patients with allergy. Partial amino acid sequences were determined for the proteins bound by IgE, and the corresponding cDNA, containing a complete coding region, was cloned by 5' and 3' rapid cDNA extension and PCR. The recombinant protein was expressed in yeast and subjected to immunoblotting.

RESULTS

We identified a full-length cDNA encoding a protein, which we named CC38K, with 335 amino acids and a molecular mass calculated as 38 kd. This amino acid sequence included all the partial amino acid sequences obtained from the purified proteins identified by IgE from patients with allergy. Recombinant CC38K protein was recognized by patients' sera, indicating that this is a major allergen present in carmine. The CC38K sequence showed homology to phospholipases.

CONCLUSION

We have, for the first time, identified the major allergen in cochineal extract. This protein may be a phospholipase or related enzyme, both of which are known to be allergens in other insects.

Pharmaceutical excipients and the information on drug labels

AIM

to evaluate the presence of preservatives, dyes, sweeteners and flavouring substances in 73 pharmaceutical preparations of 35 medicines for oral administration, according to drug labeling information about the excipients.

METHODS

35 medications were selected, both over-the-counter and prescription drugs, marketed in Brazil. The sample included: analgesic/antipyretic, antimicrobial, mucoregulatory, cough and cold, decongestant, antihistamine, bronchodilator, corticosteroid, antiinflammatory and vitamin medications. We collected data on 73 preparations of these drugs, according to drug labeling information regarding preservatives, dyes, sweeteners and flavourings.

RESULTS

Methylparaben and propylparaben were the most common preservatives found (43% and 35.6% respectively). The most common sweeteners were: sucrose (sugar) (53.4%), sodium saccharin (38.3%) and sorbitol (36.9%). Twenty-one medicines (28,7%) contained two sweeteners. Colourless medicines predominated (43.8%), followed by those with sunset yellow dye (FD&C yellow no. 6) (15%). Five products (6.8%) contained more than one colour agent. Tartrazine (FD&C yellow no. 5) was present in seven preparations (9.5%). Fruit was the most common flavouring found (83%). Labelings of drugs which contained sugar frequently omitted its exact concentration (77%). Of the four labelings of medicines which contained aspartame, two did not warn patients regarding phenylketonuria.

CONCLUSION

Omission and inaccuracy of drug labeling information on pharmaceutical excipients may expose susceptible individuals to adverse reactions caused by preservatives and dyes. Complications of inadvertent intake of sugar-containing medicines by diabetics, or aspartame intake by patients with phenylketonuria may also occur.

Excipientes de medicamentos e as informações da bula

OBJETIVO: Avaliar a presença de conservantes, corantes, adoçantes e aromatizantes em 73 apresentações farmacêuticas de 35 medicamentos para uso oral, e as informações da bula sobre excipientes. MÉTODOS: Selecionamos 35 medicamentos, de venda livre ou sob prescrição médica, comercializados no Brasil. A amostra incluiu: analgésicos/antitérmicos, antimicrobianos, mucolíticos, antitussígenos, descongestionantes, anti-histamínicos, broncodilatadores, corticosteróides, antiinflamatórios e suplementos vitamínicos. Foram analisadas 73 apresentações desses fármacos, anotando-se as informações da bula sobre conservantes, corantes, adoçantes e aromatizantes. RESULTADOS: A bula de um medicamento (1,3%) não mencionava os ingredientes inativos. Os conservantes mais encontrados nos medicamentos foram metilparabeno e propilparabeno (43% e 35,6% respectivamente). Os adoçantes mais usados foram: sacarose (açúcar) (53,4%), sacarina sódica (38,3%) e sorbitol (36,9%). Vinte e um produtos (28,7%) continham dois adoçantes. Predominaram os medicamentos sem corante (43,8%), seguidos pelos coloridos por amarelo crepúsculo (amarelo FD&C no. 6) (15%). Cinco produtos (6,8%) continham mais de um corante. A tartrazina (amarelo FD&C no. 5) foi encontrada em sete formulações (9,5%). Os aromatizantes mais usados foram os de frutas (83%). Constatamos a freqüente omissão das bulas sobre o teor exato de açúcar dos produtos (77%). Duas das quatro bulas de medicamentos contendo aspartame não mencionavam as precauções no uso por fenilcetonúricos. CONCLUSÕES: A omissão e a imprecisão das informações da bula sobre os excipientes farmacêuticos expõem os indivíduos suscetíveis ao risco de reações adversas dos conservantes e corantes. Também podem ocorrer complicações do uso inadvertido de medicamentos contendo açúcar pelos pacientes diabéticos, ou de fármacos adoçados com aspartame pelos fenilcetonúricos.

Occupational asthma to carmine in a butcher

Hypersensitivity to carmine (E120) has been identified as a cause of food intolerance and occupational asthma. We present a case of occupational asthma following exposure to carmine in a manufacturer of sausages and review the literature.

CASE REPORT

A 42-year-old non-atopic male presented with a 5-year history of rhinoconjunctivitis and asthma on occupational exposure to food additive dusts. Symptoms increased after work. The patient had been exposed for more than 20 years.

METHODS

Skin prick tests were performed with a battery of common inhalant allergens and spices. Cochineal, carmine lake and additive mixes used by the patient were extracted and subsequently used for skin prick test, bronchial provocation and in vitro measurements (specific IgE, Western blot and chromatographic fractionation).

RESULTS

Prick tests were positive to carmine and carmine-containing additives; carmine-specific IgE and bronchial challenge tests were also positive (PC20 = 0.0004 mg/ml and 1.6 kU/l). Western blot showed IgE binding to bands of about 30 kDa on cochineal extract and a diffuse pattern at 40-97 kDa on carmine. This result was confirmed by gel filtration chromatography and dot blot. Carmine completely inhibited IgE binding to cochineal extract.

DISCUSSION

Carmine is a potential sensitizer in an occupational setting: 18 cases of occupational asthma have been described to date. Carmine allergens are poorly defined; in general, proteins from cochineal not removed by the extraction process are considered as the main allergens in carmine. Our results are consistent with this, but show that these proteins may be subject to chemical modification.

Carmine (E-120)-induced occupational asthma revisited

BACKGROUND

Occupational asthma (OA) caused by carmine (E-120) has been reported.

OBJECTIVE

We sought to evaluate the prevalence of sensitization and OA at a natural dye processing factory in which 2 workers had been given a diagnosis of carmine-induced OA 6 years previously.

METHODS

The 24 current employees and one worker who had recently left work because of asthma completed a questionnaire and underwent skin testing (carmine, cochineal, carminic acid, curcuma, annato, and chlorophyll), carmine IgE dot-blot analysis, and methacholine inhalation testing. Workers exhibiting positive occupational skin test responses, work-related asthma, or bronchial hyperresponsiveness underwent specific inhalation challenge and serial peak expiratory flow rate recording.

RESULTS

Positive skin test responses to carmine (41.7%), cochineal (29.2%), and carminic acid (4.2%) were observed. Carmine IgE dot-blot results were positive in 4 subjects. No difference in atopy or smoking was observed between occupationally sensitized and nonsensitized subjects. Among the 5 employees reporting work-related asthma, 2 had positive skin test responses, and 4 had bronchial hyperresponsiveness. Five subjects underwent specific inhalation challenges: 2 workers had early asthma responses to carmine and cochineal challenges, and the remaining subjects did not have suggestive peak expiratory flow recordings. The subject who had left his job was given a diagnosis of carmine-induced OA.

CONCLUSION

The prevalence of sensitization and OA caused by carmine was 41.6% and 8.3%, respectively. When the 3 workers who had left their jobs were included, the cumulative incidence of sensitization and OA was 48.1% and 18.5%, resembling the healthy worker effect. Prevention programs to establish the permissible levels of airborne allergen should be implemented.