Alaska News

Could pot-infused edibles be causing my runny nose and sneezing?

Chris wonders after a previous Highly Informed column noted that alternatives to smoking cannabis aren't without potential risks: "I've been a daily user of edibles and am feeling like I've become allergic: runny nose, stuffed sinus, sneezing etc. Is this a possible side effect?"

First off, it is possible for people to be allergic to cannabis, and the indications so far are that such allergies respond to common treatments. Cannabis, like many other plants, weeds and grasses, can cause the immune system to overreact in defense. That overreaction is what we call an allergy. An extreme kind of allergic reaction is known as anaphylaxis. It is severe and life-threatening, and can come upon someone in seconds. In anaphylaxis, the flood of chemicals sent by the body can cause symptoms like shock, constriction of the airway and decrease in blood pressure.

A range of symptoms are associated with allergic reactions, but they do include the ones you describe there. Dr. Phil Lieberman, who fields questions from allergists for the American Academy of Allergy, Asthma & Immunology, reviewed the literature and concluded in a 2012 column, "marijuana is capable of producing allergic reactions both in the respiratory tract via its pollination and by ingestion, causing anaphylaxis." Since that column, a one-of-a-kind case of anaphylaxis through inhalation has appeared.

Read more Highly Informed: Seeking answers to Alaska's cannabis questions

Cases of allergic reactions associated with cannabis are thought to have resulted from both THC and to proteins found in the cannabis plant. But, said Dr. Melinda Rathkopf of the Allergy, Asthma and Immunology Center of Alaska, symptoms like the sort Chris describes would be unusual as a result of ingesting an allergen in food.

She said in a phone interview that cannabis is associated with cases of contact allergies (which result from touching something) and pollen allergies (inhaling something), but that hay-fever like symptoms, known as rhinitis, are unlikely to be the result of eating something. Runny noses and sneezing are more likely to result from inhaling pollen, she said, the same way birch trees turn noses across Alaska into faucets in spring and summer.

Rathkopf said she can't rule out that Chris is allergic to cannabis, but that his symptoms indicate some cause besides the edibles. For example, she said, he might be experiencing a contact or pollen allergy if he has buds or leaves around and handles them.

It's important to note that "pollen" in this context refers to microscopic particles of protein that float around and cause problems for the human respiratory tract. While most of the pollen in the air does come from male plants, the term does not necessarily only refer to something from a male plant. Male cannabis plants are far more likely for someone to encounter in places like the Midwest, where cannabis grows wild in ditches as a hold-over from historic hemp production, compared to a place like Alaska, where most plants are female and grown indoors to produce seedless flowers. Indoor growers for recreational and medical use typically kill male plants as soon as they appear so that a crop doesn't develop seeds.

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Testing?

So it is possible that an allergy to cannabis is causing Chris's symptoms, but maybe not, and it's probably not the infused food.

According to Lieberman, if cannabis is related to your symptoms, you could even be allergic to aspergillus, a mold that can sometimes be found on finished buds and can appear in grows.

Lieberman has written a couple of explainers for the AAAAI, (linked here and here), but grab a medical dictionary if you decide to tackle them. Other physicians and experts make up his audience, not laypeople. He notes in one entry that a complete classification of the allergens in pot hasn't been created, but that one allergen present in other foods and pollens has been identified.

So how does anyone tell for sure whether they're allergic to pot? Well, it's difficult. The clinical study of cannabis allergies is, like many areas of cannabis research, still progressing. As a recently published review in the journal Annals of Allergy Asthma and Immunology notes, diagnosis of cannabis allergy is still heavily reliant on factors besides standardized clinical testing.

For a variety of reasons, there is no commercialized test yet for a cannabis allergy, but Dr. Rathkopf said that people testing allergic to weeds in general means they're more likely to be allergic to cannabis. And she has heard of cases where people who have an oral sensitivity to tomatoes or peaches (a tingling or buzzing sensation) have experienced the same symptoms with oral cannabis products.

A skin or blood test would be very useful in knowing for certain, but it's not always necessary to know for certain in order to treat an allergy.

Dr. David Engler, of Houston Allergy & Asthma Clinic in Houston, Texas, said that in the successful treatment of an unusual case of cannabis-related anaphylaxis in a police detective, he was unable to confirm with a clinical test that pot was indeed causing the reaction. That reaction was unusually severe, he said, and the case very rare.

"To my knowledge a series of one," he said of his patient.

There are five grades of anaphylaxis, grade 5 being death, and Engler's patient would jump right to stage 4 within seconds of casual exposure to cannabis smoke or pollen. Grade 4 includes a drop in blood pressure and a loss of consciousness, and without immediate intervention, can kill a person.

In an interview during the home leg of his daily commute, Engler said on speakerphone that the detective sometimes encountered pot during the course of her job, and after a series of attempts with other drugs to "teflon-coat" her against casual exposure, they settled on one drug that has succeeded in removing the dire threat to her life. A harbinger symptom, a specific warning sign that an anaphylactic attack is about to happen, still appears for her when pollen or smoke are present, but with the treatment, she doesn't have to go quickly for her epinephrine auto-injectors.

During his effort to treat the detective, Engler called research clinics to see about a blood test to confirm a cannabis allergy, but came up short, and he finally happened upon a procedure that another clinic used to create a skin test. The method involved grinding up buds, and his office manager called the DEA for permission. He said the agency denied the request and warned of consequences if he created the test without permission, saying they had his name now.

"So," Engler said, "we're making a bit of an assumption that she's allergic, but you know, I'm also making an assumption that gravity works because my car is still on the road."

Treatments and the future

So far, understanding is incomplete, but the indications are that cannabis allergies are very similar to other allergies, and standard treatments and tests may eventually become widespread, but work is still being done. And there is reason to believe that cases of cannabis allergy are being more frequently reported since prohibition has waned in some states. Although, that's not the same as saying such allergies are occurring more frequently since the advent of legalization, that possibility does exist.

Because of the checkered illegality of the substance across the country, cases of cannabis allergy still aren't commonly seen, a fact expected to change with more states allowing adult use. And because of the continued illegality at the federal level, research opportunities are limited, although policy softened slightly last month. Both of those factors were obstacles to further understanding that physicians pointed to in our conversations.

As for treatments, Dr. Lieberman, explainer for the AAAAI, wrote in a column that there is some indication that sensitization treatments (a process of injections) could help people overcome marijuana allergies as they have in the case of other allergies, but that it would require further study.

Dr. Engler said of the current status of cannabis research, "There are lots of unanswered questions, but I don't think the answer to those questions is continued prohibition. My patient is scared to death it'll be legalized in Texas, but I think that's about 20 years away."

Understanding is increasing, though, even among experts. Engler said that his patient was turned away many times when she first sought treatment, with clinics saying that she was told, "That allergy doesn't exist," or "We don't treat those things."

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But, as many are learning, yes, it is possible to be allergic to cannabis, from mildly to severely. But it's more likely that Chris's symptoms are being caused by airborne allergens than by cannabis-infused edibles.

Have a question about marijuana news or culture in Alaska? Send it to cannabis-north@alaskadispatch.com with "Highly Informed" in the subject line.

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