Case report: A first case of flaxseed-induced anaphylaxis in Korea

RATIONALE

Anaphylaxis is a serious, generalized allergic reaction typically triggered by drugs, food, and bee venom, which can be life-threatening. Seeds are one of the major food allergens and can cause anaphylaxis as well as systemic hypersensitivity reactions. Flaxseed has been widely used crop for numerous purposes, such as in alternative medicine and as a dietary supplement, hypersensitivity to it has rarely been reported.

PATIENT CONCERNS

A 42-year-old female presenting with facial edema, dyspnea and urticaria after ingested half teaspoon of flaxseed flour 30 minutes previously.

DIAGNOSES

A skin prick test for heated flaxseed flour extract showed negative responses, but intradermal test showed positivity which suggested an Immunoglobulin E-mediated reaction.

INTERVENTIONS

The patient was instructed to avoid future ingestion of flaxseed.

OUTCOMES

The patient had no recurrence of symptoms at 1-year follow-up.

LESSONS

This is the first case of flaxseed-induced anaphylaxis in Korea, confirmed by an intradermal skin test.

Effect of including whole linseed and vitamin E in the diet of young bulls slaughtered at two fat covers on the sensory quality of beef packaged in two different packaging systems

BACKGROUND

Forty-six Pirenaica young bulls, slaughtered at two levels of fatness (3 and 4 mm), were used to evaluate the effect of the inclusion of 50 g kg^-1 linseed alone or with 200 IU vitamin E kg^-1 in the concentrate and of the meat packaging system (vacuum or modified atmosphere packaging (MAP)) on the beef sensory quality.

RESULTS

The inclusion of linseed or supplementation with vitamin E in the concentrate induced no significant differences in the main meat sensory scores and overall appraisal except under MAP, where small differences due to concentrate ingredients were found in juiciness and metallic flavor intensity. Extending the display time up to 4 or 8 days in high-oxygen MAP had detrimental effects on sensory attributes. Meat from animals with 4 mm fat cover depth were rated more tender and juicy, less fibrous and with a higher intensity of beef flavor and rancid odor than meat from 3 mm fat cover bulls when both samples were vacuum packaged.

CONCLUSION

The inclusion of 50 g kg^-1 linseed in the concentrate fed to bulls had no detrimental effect on the beef sensory quality. The vacuum-packaged meat of bulls slaughtered at 4 mm fat cover was rated higher on sensory analysis than that at 3 mm fat cover. © 2016 Society of Chemical Industry.

A Review of the Efficacy, Safety, and Clinical Implications of Naturally Derived Dietary Supplements for Dyslipidemia

Dyslipidemia is recognized as a major cause of cardiovascular disease. A number of evidence-based guidelines recommend conventional synthetic drugs as standard therapy for dyslipidemia in clinical practice. However, antihyperlipidemic drugs have some serious side effects. Naturally derived dietary supplements are becoming attractive as an alternative strategy because of their high efficacy and safety, as supported by numerous data. Moreover, they could be considered an initial treatment for dyslipidemia. The aims of this literature review were to demonstrate the efficacy, safety, and clinical implications of dietary supplements for treating dyslipidemia. We reviewed the literature, including data from in vitro, in vivo, and human studies, and clinical guideline recommendations. We classified dietary supplements by their proposed mechanisms of action on lipid metabolism and also collected daily dosage recommendations, interactions with concurrent drugs and/or foods, dosage forms, and examples of commercially available products. Various types of naturally derived dietary supplements exhibit lipid-improving properties. Efficacy and safety are acceptable; however, their use in clinical practice will require further well-designed investigations and the support of scientific data.

Effect of Flaxseed Intervention on Inflammatory Marker C-Reactive Protein: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Functional food-flaxseed and its derivatives (flaxseed oil or lignans) are beneficial for human health, possibly because of their anti-inflammatory effects. C-reactive protein (CRP), a sensitive marker of inflammation was chosen to evaluate the anti-inflammatory effects of flaxseed. We searched randomized controlled trials from PubMed and the Cochrane Library in October 2015 and conducted a meta-analysis to evaluate the effectiveness of flaxseed and its derivatives on CRP. The mean differences (net change) in CRP (mg/L) concentrations were pooled with a random- or a fixed-effects model depending on the results of heterogeneity tests. Overall, flaxseed interventions had no effects on reduction of CRP (p = 0.428). The null effects were consistent in the subgroup analysis with multiple studies and population characteristics. Significant heterogeneity was observed in most of the analyses. Meta-regression identified baseline body mass index (BMI) as a significant source of heterogeneity (P-interaction = 0.032), with a significant reduction in CRP of 0.83 mg/L (95% confidence interval −1.34 to −0.31; p = 0.002) among subjects with a BMI of ≥30 kg/m². In conclusion, our meta-analysis did not find sufficient evidence that flaxseed and its derivatives have a beneficial effect on reducing circulating CRP. However, they may significantly reduce CRP in obese populations.

[Case report: anaphylaxis caused by linseed included in baked bread]

We recently experienced a 29-year-old female with anaphylaxis caused by linseed included in homemade bread. This is the first report of linseed-induced allergy in Japan. She obtained the linseed-containing ingredients of bread by mail order. We performed skin-prick tests and basophil degranulation tests using extracts of the ingredients and commercially available linseeds; both tests showed positive results for linseed. The patient's serum was also positive for linseed-specific IgE. Since linseeds are included in various kinds of foods and exposure to them is increasing, linseeds may need to be recognized as a potential trigger of immediate-type allergy in Japan.

No evidence of hypoglycemia or hypotension in older adults during 6 months of flax lignan supplementation in a randomized controlled trial: a safety evaluation

CONTEXT

The natural health product, BeneFlax, is a standardized flaxseed [Linum usitatissimum L. (Linaceae)] lignan enriched product with evidence of product quality and known quantity of the bioactive component, lignan. The acceptance of this natural health product for its various health benefits requires greater evidence of its safety in the general population.

OBJECTIVE

We determined whether flaxseed lignan causes clinical hypoglycemia or hypotension in healthy older adults as an important aspect of safety.

MATERIALS AND METHODS

Participants aged 49-87 years were randomized in a double-blind trial to receive flaxseed lignan (543 mg/day in BeneFlax) or placebo while completing a 6-month walking program. The 94 participants who completed the study were stratified by age (<65 years versus ≥65 years) and treatment category to determine whether older adults were more susceptible to adverse effects.

RESULTS

After 6 months of treatment, average plasma glucose level (5.4 ± 0.6 mmol/L), systolic blood pressure (127 ± 14 mm Hg), and diastolic blood pressure (80 ± 9 mm Hg) were within normal clinical range. Controlling for sex and body mass index covariates resulted in no observed differences between plasma glucose or blood pressure measurements between treatment or age groups (p > 0.05). No incidents of hypoglycemia or hypotension were observed during BeneFlax treatment, suggesting that 543 mg falls at or below the no observable adverse effect level (NOAEL).

DISCUSSION AND CONCLUSION

These data suggest the flaxseed lignan product BeneFlax does not pose a risk of hypoglycemia or hypotension in healthy adults aged 49-87 years.

Exposure to specific herbal products during pregnancy and the risk of low birth weight

CONTEXT

Despite the fact that herbal products (HP) are used frequently during gestation worldwide, studies indicate that they may not be free of danger for fetuses. Evidence about the safety of HP use during pregnancy and their impact on pregnancy outcomes is currently lacking.

OBJECTIVE

To quantify the association between HP use during the last 2 trimesters of pregnancy (≥15 weeks of gestation [WG]) and more specifically, between use of chamomile (Anthemis nobilis), flax (Linum usitatissimum), peppermint (M. balsamea), or green tea (Camellia sinensis) (alone or in combination with other HPs) and the risk of low birth weight (LBW).

DESIGN

We evaluated data from the Quebec Pregnancy Registry, which was created by the linkage of 3 administrative databases in Quebec, and a self-administered questionnaire mailed to subjects. Participants 8505 women were randomly selected from the registry. Overall, 38.5% of women (n = 3273) returned their questionnaires, and 3183 were included in the study (8 were excluded because of missing values on birth weight or giving birth to twins or triplets). Outcome measures We performed a case-control analysis. Cases were defined as women who delivered a newborn <2500g and controls as women who delivered a newborn ≥2500g. Multivariate logistic regression models were used to analyze data.

RESULTS

Amongst the selected 3183 participants, 424 (13.32%) were cases. After adjusting for potential confounders, no statistically significant associations were found between the use of any HP during the last 2 trimesters of pregnancy and the risk of LBW, or between the use of flax, chamomile, peppermint, or green tea (alone or in combination with other HPs) during the last 2 trimesters of pregnancy and the risk of LBW.

CONCLUSION

HP use during the last 2 trimesters of pregnancy and more specifically, use of flax, chamomile, peppermint, or green tea alone or in combination with other HPs did not significantly increase the risk of LBW.

Maternal dietary exposure to fiber during pregnancy and mammary tumorigenesis among rat offspring

Maternal diet during pregnancy has been proposed to modify female offspring's later susceptibility to develop breast cancer; however, most of the dietary factors identified thus far have led to increased risk. To identify dietary factors that might reduce offspring's breast cancer risk, pregnant rat dams were fed diets containing 6% fiber originating either from cellulose (control), or oat, whole wheat or defatted flax flour. At birth, dams were switched to the AIN93 semi-purified diet. Mammary tumor incidence and multiplicity, induced by administering the offspring 5 mg 7,12-dimethylbenz[a]anthracene (DMBA) at the age of 50 days, was reduced in the whole wheat flour-exposed offspring and increased in the defatted flax-exposed offspring. To identify the mechanisms mediating the effects of in utero dietary exposures, changes in mammary gland morphology and gene expression were assessed before puberty onset (3 weeks of age) and at the time rats are most susceptible to malignant transformation (8 weeks of age). The number of terminal end buds (TEBs), i.e., the targets of malignant transformation, was reduced in the mammary glands of whole wheat- and oat flour-exposed offspring, as compared to the controls. Further, the number of apoptotic epithelial cells (based on ISOL assay) was elevated in the whole wheat flour offspring, but no changes in cell proliferation (PCNA), estrogen receptor alpha (ER-alpha) or cyclin D1 mRNA or protein levels were seen. The mRNA and/or protein levels of BRCA1 and p53 were significantly increased in the mammary glands of whole wheat flour offspring. Further, the levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of DNA damage, were significantly reduced in these rats, suggesting that maternal dietary exposure to whole wheat during pregnancy may reduce offspring's breast cancer risk by improving DNA damage repair mechanisms.

Effects of a diet rich in phytoestrogens on prostate-specific antigen and sex hormones in men diagnosed with prostate cancer

OBJECTIVES

To determine the effects of diets rich in soy and linseed compared with a control diet on biochemical markers of prostate cancer in men diagnosed with prostate cancer.

METHODS

Twenty-nine men diagnosed with prostate cancer and scheduled to undergo a radical prostatectomy were randomized to one of three groups: soy (high phytoestrogen), soy and linseed (high phytoestrogen), or wheat (low phytoestrogen). A bread was specially manufactured to incorporate 50 g of heat-treated (HT) soy grits or 50 g of HT soy grits and 20 g of linseed as part of the study participant's daily diet. Baseline and preoperative levels of prostate-specific antigen (PSA), free PSA, testosterone, sex hormone-binding globulin, free androgen index, and dihydrotestosterone were measured.

RESULTS

Statistically significant differences were detected between the HT soy grits group and the control wheat group for the percentage of change in total PSA (-12.7% versus 40%, P = 0.02) and the percentage of change in free/total PSA ratio (27.4% versus -15.6%, P = 0.01); and between the HT soy grits group and the HT soy grits and linseed group for the percentage of change in free androgen index (16.4% versus -15.5%, P = 0.04) and the percentage of change in free/total PSA ratio (27.4% versus -10%, P = 0.007).

CONCLUSIONS

The data from this study indicate that a daily diet containing four slices of a bread rich in HT soy grits favorably influences the PSA level and the free/total PSA ratio in patients with prostate cancer. This work provides some evidence to support epidemiologic studies claiming that male populations who consume high phytoestrogen diets have a reduced risk of prostate cancer development and progression.

The effects of dietary flaxseed on the Fischer 344 rat: II. liverγ-glutamyltranspeptidase activity

The effect of 10% flax chow consumption from the 30th to the 130th day after birth was examined in male Fischer 344 rats. The effects of both the high lignan/high oil Norlin strain and a high lignan/low oil Solin strain of flaxseed were compared. Physically and behaviourally there were no differences in rats belonging to the three dietary groups at any time. At 50 and 100 days of dietary exposure, blood glucose levels were the same in Norlin and Solin flax chow-fed and as well as regular chow-fed rats; there were no signs of toxicity in the Norlin and Solin flax-fed rats since their plasma levels of alanine aminotransferase were the same and equal to those of regular chow-fed rats. The activity of gamma-glutamyltranspeptidase (gammaGT) displayed an increase in the liver homogenates of flax chow-fed rats. This increase was the same in Norlin and Solin flax-fed rats at 50 and 100 days. Thus the liver effect was not oil, but lignan, likely secoisolariciresinol diglucoside (SDG), induced and was effected early on, and sustained, after flax exposure. The degree of heat activation of liver homogenate gammaGT was the same in regular chow-fed and flax chow-fed rats. Compared to liver homogenate gammaGT activity, the soluble form of gammaGT was expressed at very low levels while the plasma membrane-bound form of gammaGT was expressed at very high levels in rat liver in both regular chow-fed and flax chow-fed rats. There was no effect of flax feeding on the soluble form of liver gammaGT which was expressed at a very low level. Flax feeding effected an increase in the activity of gammaGT in isolated plasma membrane fractions which mirrored that in liver homogenates: the same degree of increase was seen in Norlin flax chow-fed and Solin flax chow-fed rats. Flax consumption effects an increase in the activity of liver gammaGT at the level of the plasma membrane which is lignan dependent, physiologically relevant and may be linked to hepatoprotection against injury through an increase in reduced glutathione.

John Pemberton and the flax industry in Northern Ireland

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Long-term effects of feeding flaxseed on performance and egg fatty acid composition of brown and white hens

Two hundred fifty-six 18-wk-old Shaver White and ISA-Brown pullets were fed commercial diets containing either 0 or 10% flaxseed in order to study the long-term effects of feeding flaxseed on hen performance and egg production parameters. Performance was monitored over 10 consecutive 28-d periods. Flaxseed was introduced gradually at 28 wk of age and was maintained until hens were 53 wk of age, when flaxseed was gradually eliminated from the diet. Feed intake was less (P < 0.05) for hens fed flaxseed compared to those consuming the control diet. Flax-fed hens were also lighter (P < 0.05) compared to the control birds. Egg production, egg weight, shell weight, albumen height, and shell thickness were not significantly (P > 0.05) different for hens consuming 0 and 10% flaxseed; however, yolk weight was reduced (P < 0.05) in hens fed flaxseed. Both strains of birds fed flaxseed deposited significantly more n-3 fatty acids into their eggs. Sampling of livers at the end of the trial showed that hens fed flaxseed had a higher (P < 0.05) incidence of liver hemorrhages.

Anaphylaxis to Linum

BACKGROUND

Flax (Linum usitatissimum) seeds are increasingly used in bread and as laxatives. Hypersensitivity to linseeds has been infrequently described, and we report a case of anaphylaxis induced by linseed ingestion in a 39-year-old woman.

METHODS AND RESULTS

The clinical course, as well as positive skin prick tests and histamine release tests performed with linseed extracts, suggested a type I hypersensitivity as the underlying cause for the patient's multisystemic involvement. The presence of linum-specific IgE in her serum was confirmed by immunoCAP assay.

CONCLUSION

Linum seeds might be a source of allergic sensitization that should be taken into account due to its widespread distribution at health food stores.

Exposure to flaxseed and its purified lignan reduces bone strength in young but not older male rats

Flaxseed is the richest source of the plant lignan secoisolariciresinol diglycoside (SDG), which is converted to the two major mammalian lignans, enterodiol (ED) and enterolactone (EL), by colonic bacteria. Because both ED and EL can produce biological effects similar to estrogen, exposure to lignans during early stages of development may adversely alter the normal development of bone in males since bone is a hormone-sensitive tissue. To determine whether early exposure to flaxseed or its lignan compromised the acquisition of bone mass or reduced bone strength, male offspring were exposed to one of three diets during lactation only (birth through postnatal day [PND] 21) via mother's milk or continuously from the start of lactation through to adolescence (PND 50) or young adulthood (PND 132). The diets were a basal diet (BD) that was devoid of phytoestrogens, BD containing 10% flaxseed, or BD containing the equivalent quantity of SDG present in a 10% flaxseed diet. To assess bone quantity, the bone mineral content (BMC) and bone mineral density (BMD) of femurs were assessed by dual-energy x-ray absorptiometry. Since the biomechanical properties of bone are indicators of the microarchitecture and thus bone quality, the biomechanical strength of femurs was assessed by three-point bending. At PND 50, ultimate bending stress and Young's modulus, measures of bone strength, were reduced among rats that received the 10% flaxseed diet from PND 0 through PND 50, while there were no marked differences in bone size, BMC, or BMD among groups. Interestingly, this effect does not appear to be due to the lignan in flaxseed, as continuous exposure to the diet containing the equivalent quantity of lignan (10 S diet) did not alter any measures of bone strength. In contrast to PND 50, bone strength did not differ among groups at PND 132, indicating that the compromise in bone strength was not sustained into early adulthood. Bone size, BMC, and BMD continued to be similar among treatment groups at PND 132. In conclusion, exposing male rats to a diet containing 10% flaxseed or an equivalent quantity of lignan either during lactation only or through to early adulthood is safe with respect to bone health, as measures of bone mass and strength were similar to control rats.