IJT - CIR - February 2024 - 21S

Becker et al.
21S
Table 14. Case Reports of Sensitization to Humulus lupulus (Hops).
Presentation
A 57-years-old female farmer presented with occupational
airborne dermatitis and hand dermatitis from Humulus lupulus
(hops)
Data, Tests, and Results
Disease appeared at the age of 46, after 30 years of working
with Humulus lupulus (hops) without any health problems.
Patient had erythema of the skin of face, neck and upper
chest, edema of eyelids, conjunctivitis, as well as acute
dermatitis of hands. Symptoms were provoked by exposure
to fresh or dried Humulus lupulus (hops). Symptoms
appeared after 30 min of work and persisted over 1 to 2
days. There were no other skin or allergic problems. Skin
tests were conducted with Humulus lupulus (hops) leaves
(saline extract: prick positive, patch negative; glycerol
extract: prick positive, patch negative) and hop strobiles
(saline extract: prick positive, patch negative; glycerol
extract: prick negative, patch positive after 48 and 72 h).
Despite discontinuing work, patient experienced several
relapses of her dermatitis. A cream and an herbal sedative,
both containing Humulus lupulus (hops) extract, were
identified as causing her dermatitis. During next Humulus
lupulus (hops) cultivation period it also turned out that
physical proximity to her husband was provoking relapses of
the patient's dermatitis. Husband said that sometimes he did
not wash thoroughly after working with the plant.
An atopic 35-year-old male brewery worker with
rhinoconjunctivitis diagnosis due to grass and olea pollen
presented with occupational rhinoconjunctivitis after 3 years
of exposure to Humulus lupulus (hops).
Subject had no symptoms when he was away from his
workplace. He was able to drink beer without symptoms.
An SPT with a common commercial inhalants battery
including pollens, mites, animal dander, molds, and latex was
performed. Additionally, SPTs were performed using
Humulus lupulus (hops) and barley extracts. Assays for
specific IgE to barley, malt, corn, wheat and hops were also
carried out. To demonstrate the patient's symptoms, a nasal
challenge with Humulus lupulus (hops) extract was
performed. SPTs were positive to grass, olive pollen, and
Humulus lupulus (hops). Specific IgE was positive only to
Humulus lupulus (hops). Nasal challenge with Humulus
lupulus (hops) extract reproduced an immediate nasal
response. SPTs with Humulus lupulus (hops) controls
subjects (n = 10) were negative.
A 29-year- old male subject, who had three episodes of urticaria-
angioedema immediately after ingestion of peanuts, chestnuts,
and banana over the last 4 years, the latter requiring
emergency treatment. Subject presented with urticaria on
both hands while working with ripe dried Humulus lupulus
(hops), though not with fresh Humulus lupulus (hops).
SPTs were negative for common aeroallergens (soy, latex,
rapeseed, and the fish nematode Anisakis simplex) and
positive for wheat and corn; controls (histamine and normal
saline) had expected results. SPTs for banana, chestnut,
walnut, almond, kiwi, avocado, and ripe dried Humulus
lupulus (hops) were positive. Two additional atopic subjects
served as controls; they had negative results for ripe dried
Humulus lupulus (hops). Specific IgE to chestnut was 1.69kU/
L, and ripe dried hops: 1.00 kU/L: total IgE: 64 IU/mL.
Authors commented that Humulus lupulus (hops) rash as
skin irritation has been known for several decades, but this
subject could not be included in this category. A diagnosis of
immunological contact urticaria due to dried Humulus
lupulus (hops) by was made because: 1) work-related
symptoms from handling dried Humulus lupulus (hops), but
not fresh, 2) positive SPT, and 3) positive specific IgE.
Authors hypothesized that Humulus lupulus (hops) drying
process may transform certain proteins into allergens.
Authors were not able to conclude if cross-reactivity
between various fruits and dried Humulus lupulus (hops) was
feasible.
Reference
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