Table 4: Case reports of adverse events associated with human exposure to cruciferous plants, their derivatives or their constituents.

Reference    Patient details            Intervention                       Outcome
AgeConcurrent conditions/
treatments
Plant/
substance
Route1Duration2Dose3Adverse eventsAcute managementOutcome4Causality5Comments

Blaiss et al. 1987 [53]21In the past allergic rhinitis to numerous inhalant allergens: grasses, milds, ragweed, and dust mite. Immunotherapy to grass and dust allergens stopped a year prior to reported eventsCabbage (in coleslaw)Oral2 acute ingestionsNot specifiedAnaphylaxis: pain and swelling in mouth and throat with difficult breathing. Swelling of lip, tongue, soft palate. No diffuse urticaria, wheezing or hypotensionSubcutaneous epinephrine, discharged on oral antihistamines and steroidsFull resolutionCertainlySkin test also revealed allergy to mustard, cauliflower, and broccoli. Reexposure to coleslaw via oral ingestion after 2 weeks triggered same symptoms

Brito et al. 2001 [54]29 and 37Not givenDiplotaxis erucoides (wall rocket) pollenRespiratory2 months every yearNAPatient 1: rhinoconjunctivitis
Patient 2: rhinoconjunctivitis and asthma. Patients were tested and found to be allergic to Diplotaxis erucoides pollen
Not mentioned LikelyOccupational exposure

Compes et al. 2007 [55]38Ex-smoker, with a personal history of house dust mite allergic rhinitis and asthma, and a family history of atopyTurnip seedsTopical and respiratoryChronic (exact duration not mentioned)NARhinitis and asthma. Patient was tested and found to be allergic to turnip seedsNot mentionedNot mentionedPossiblyBird fancier. Patient was also found to be allergic to avian antigens

Caldan 1981 [56]28Eczema and hay fever. In the past contact with other vegetables caused itchingCabbageTopicalNot reported (unclear whether chronic eczema is related to cabbage exposure)NAContact urticaria. Patch test revealed allergy to “green leaves” (cabbage and Brusselss sprouts)Not mentionedNot mentionedPossiblyPaper lacks many details regarding both urticaria and eczema

Chakrabarti et al. 2003 [57]563-year history of severe eczema and recurrent blisters on palms BroccoliTopical Chronic (exact duration not mentioned)NAAllergic contact dermatitis (worsening of eczema)Subcutaneous epinephrine, discharged on oral antihistamines and steroidsPartial resolution: eczema improved upon avoidance of topical contact with broccoli and other vegetablesPossiblyPatient refused patch tests to other vegetables, but it is possible that she is allergic not only to broccoli

Dannaker et al. 1987 [58]382 year history of hand dermatitis; 6 months history of dryness and scaling at angles of mouth (Unclear whether her hand dermatitis is related to mustard exposure)Mustard in salad dressingsTopicalChronic, for the past 3 yearsNAAcute episode of allergic contact dermatitisNot mentionedNot mentionedPossiblyOccupational exposure

Di Giacomo et al. 1998 [59]48Not givenOilseed rape flourRespiratoryChronic (exact duration not mentioned)NAEpisodes of asthma and rhinoconjunctivitis Allergy tests showed that skin prick tests were only mildly positive for oilseed rape flour, and the peak respiratory flow only slightly decreased during exposureNot mentionedNot mentionedPossiblyOccupational exposure

Hernandez et al. 2005 [60]70Allergies to some fruit and nuts, seasonal allergic rhinoconjunctivitisCauliflowerOralAcute ingestionNot specifiedOropharyngeal itching, facial and hand swelling, severe bronchospasmRequired emergency room consultFull resolutionPossiblyNo details of what other components the dish included

Jorro et al. 1995 [61]43, 17, and 19Patient 1: history of IgE-dependent rhinitis since childhood; urticaria angioedema episodes related with shellfish. Patient 2: history of IgE-dependent asthma and rhinitis and urticaria to latex. Patient 3: history of IgE-dependent rhinitisMustard sauceOral Acute ingestionsNot specifiedPatient 1: episodes of pruritus, swelling of tongue, dysphagia, dysphonia, facial edema, and progressive upper respiratory difficulty. On one occasion, he experienced hypotension, and on another urticaria and palpebral edema. Patient 2: episodes of pruritus, swelling of lips and tongue, and edema. Patient 3: dysphonia, dysphagia, progressive upper respiratory difficulty, and generalized urticaria. Upon allergy testing, patients were found to be allergic to mustardNot mentionedFull resolutionLikelyNone

Lingelbach et al. 2003 [62]40For the past 11 years: episodes of exercise-induced anaphylaxis after eating, once or twice a yearCabbage and mustardOralAcute ingestionsNAAnaphylaxis induced by exercise after ingestion of cabbage or mustardIV adrenaline, antihistamine, and corticosteroidsFull resolution LikelyPatient was also found to be allergic to other foods

Meding 1985 [63]40Vesicular hand eczema for the past 9 years, sometimes worsened for no clear reason, and also after every mustard ingestionMustard and rapeseedOral (however, allergy testing was topical)Acute ingestionsNot specifiedVesicular episodes (worsening of eczema). Positive skin prick test to crushed seeds of rapeseedNot mentionedPartial resolution: eczema improved upon avoidance of mustard and rapeseedPossiblyApart from ingestion, patient was also occupationally exposed to rapeseed

Pasricha et al. 1985 [64]35 and 47Patient 1 had suffered from dermatitis ever since she was 15, which worsened when handling cattle food. Patient 2: itching and erythematous papules for the past 1.5 years, for which she was treatedPatient 1: mustard; Patient 2: mustard khalTopical Chronic (exact duration not mentioned)NAPatient 1: itching and erythmatous papular lesions on forearms, arms, neck, forehead, ear lobules, and sides of face for the past 8 months. Patient 2: itching and erythmatous papules on forearms, forehead, cheeks, ear lobules, neck, and dorsum of feet for the past 1.5 years. Upon allergy testing, patient 1 found to be allergic to mustard, jowar flour, and wheat flour. Patient 2 found to be allergic to mustard khal and maizeNot mentioned (it is mentioned that treatment was given, but no further details are provided)Improved with treatment, but authors do not mention what happens when not exposedPossibly (patient 1), unlikely (patient 2)Patient 1 had been using mustard oil for years and only lately did she start experiencing adverse event. Patient 2 did not report any exposure to mustard

Quirce et al. 2005 [65]41Allergic rhinoconjunctivitis to pollen. For past 7 years: episodes of ocular and nasal itching, sneezing, watery nose, tearing, dry cough, chest tightness, and dyspnea after inhaling cauliflower or cabbage vaporsCabbageOralAcute ingestionNot specifiedGeneralized urticaria, facial and oropharyngeal angioedema. Upon allergy testing (with cabbage or cauliflower): severe rhinoconjunctivitis and an early asthmatic reactionRequired emergency room consultFull resolution PossiblyOccupational exposure

Rosenberg and Gervais 1986 [66]42 and 34Patient 1: asthma triggered by isocyanate paint. Patient 2: ex-smoker, asthma triggered by isocyanate paintPatient 1: mustard and horseradish. Patient 2: mustard, radish, turnipOralAcute ingestionsNot specifiedPatient 1: face flushing, asthma attack. Patient 2: asthma attackPatient 1: not mentioned; Patient 2: hospitalized, treated w/theophyllineFull resolution. In patient 2: recurrence when eating mustard/radishLikelyOccupational exposure. No testing done for food allergies in either patients

Sanchez-Guerrero and Escudero 1998 [67]36 and 54Patient 1: for past 7 years: pruritus, erythema, vesicles, fissures, and peeling in both hands, as well as facial angioedema, within 6–8 h after handling broccoli. Patient 2: asthma; in past 4 years, papules and vesicles in both hands and eyelids 24–36 hours after exposure to cauliflower or broccoliBroccoli or cauliflowerTopical Chronic (exact duration not mentioned)NAPatient 1: acute episodes of contact dermatitis after handling broccoli; Patient 2: acute episodes of contact dermatitis after handling broccoli or cauliflowerNot mentionedPatient 1: full resolution after avoiding broccoli. Patient 2: no resolution even when avoids allergensPossiblyOccupational exposure

Schulze and Wollina 2003 [68]19Not givenMustard (sauce and oil)Oral and topicalvaries (acute to chronic)Not specifiedAt 4 years of age-topical exposure caused eye lacrimation and cauterization, and dyspnea. Upon ingestion at age of 19: angioedema and bronchospasmTopical and oral antihistaminesNot mentioned PossiblySome mustard allergy tests were positive but rubbing test was negative. Cross-reactivity with other Brassica

Suh et al. 1998 [69]43Smoker; cough and chest painOilseed rape dustRespiratoryChronicNAAggravation of cough and chest painNot mentionedNot mentionedPossiblyOccupational exposure; allergy testing not performed

Valero et al. 1995 [70]34, 31, 25, 52, and 33Patient 1: house dust allergy. Patient 2: seasonal rhinitis. Patient 3: peach allergy; seasonal rhinitis; familial atopy. Patient 4: seasonal rhinoconjuctivitis and bronchial asthma, family pollen allergy.Mustard sauce or mustard pollenOral and respiratoryAcute (ingestion) to seasonal (pollen inhalation)Not specifiedPatient 1–3: urticaria, facial edema, rhinoconjunctivitis/rhinitis. Patient 4: facial edema, bronchospasm, rhinitis. Patient 5: urticaria, facial edema, and bronchospasm. All found to be allergic to mustardNot mentionedFull resolutionPossiblyNone

van Ketel et al. 1975 [71]43Eczema in past 10 yearsCauliflowerTopical Chronic (exact duration not mentioned)NAAggravation of eczema. Upon allergy testing was found allergic to both cauliflower and other Brassica: Brusselss sprouts and red cabbageNot mentionedNot mentionedPossiblyOccupational exposure. Aggravation of eczema also occurs after contact with onions, tulip bulbs, rubber gloves, and pesticides, but to a lesser extent

Widstrom and Johansson 1986 [72]25As a child, severe atopic dermatitis, rhinitis and swelling of throat in reaction to fish or egg. Currently, rhinitis when exposed to cats or dogsMustard (in mustard sauce or mayonnaise)OralAcute ingestionsNot specifiedAcute episodes of urticaria and angioneurotic edema of face and neck. Upon allergy testing was found to be allergic to mustardNot mentionedFull resolution PossiblyNone

Zawar 2005 [73]25HealthyMustard oilTopicalSeveral acute applicationsNACutaneous lesions similar to pityriasis rosea (appeared after first application)Corticosteroids and antihistaminesFull resolution followed by recurrence on re-exposureCertainlyNone

Walker 1984 [74]35Prosthetic aortic valve, history of myocardial infarctions with prolonged prothrombin time. Treated with warfarin and dipyridamoleLettuce and greens (e.g., turnip, mustard greens, broccoli)Oral5 weeksNot specified. Authors do mention, however, that vitamin K intake was 6000 μg per dayDiet-induced warfarin resistance which led to substernal chest pain and myocardial infarctionReferred to hospital, where she was treated with nitroglycerin and heparinFull resolutionLikelyVitamin K consumption was 60 times more than the norm (360 μg)

Kempin 1983 [75]Not givenPatient 1: pulmonary embolism; Patient 2: cardiovascular disease (not specified which). Treated with heparin and Coumadin (=warfarin)BroccoliOral Chronic (exact duration not mentioned)Up to 450 g/dayWarfarin resistanceCoumadin anticoagulation in patient 2Full resolutionLikelyNone

Geier 1991 [76]45BronchitisHome-made mustard wrap, containing ground mustard seeds and waterTopicalAcute application (20 minutes)Not specifiedToxic irritative dermatitisTopical corticosteroidsFull resolutionPossiblyAuthors labeled case as toxic irritative dermatitis and NOT an allergic reaction and warn against use of home-made medications

1Route of exposure.
2Duration of exposure.
3NA, not applicable, in cases where dose cannot be quantified.
4Degree of resolution in cases here adverse events were reported; NA, not applicable.
5The degree of association between the intervention and the adverse event, as rated by reviewers; NA, not applicable.