What are the management and treatment options for a nightshade allergy?

From the Guidelines

Management of a nightshade allergy primarily involves strict avoidance of nightshade foods and carrying an epinephrine auto-injector for emergency situations, as recommended by the most recent guidelines 1. The first step is to identify and eliminate nightshade foods from your diet, including tomatoes, potatoes, eggplants, peppers, and goji berries, and carefully reading food labels for hidden ingredients like potato starch or tomato paste. For symptom relief during allergic reactions, over-the-counter antihistamines such as cetirizine (Zyrtec) 10mg daily, diphenhydramine (Benadryl) 25-50mg every 4-6 hours, or loratadine (Claritin) 10mg daily can help reduce itching, hives, and mild swelling, as suggested by previous studies 1. Some key points to consider in managing a nightshade allergy include:

• Strict avoidance of nightshade foods
• Carrying an epinephrine auto-injector at all times
• Using antihistamines for symptom relief during allergic reactions
• Working with an allergist to develop a personalized emergency action plan
• Considering nutritional counseling to ensure adequate nutrient intake despite dietary restrictions It's essential to work with an allergist to confirm the allergy through skin prick tests or blood tests and develop a personalized emergency action plan, as emphasized by recent research 1. The allergic response occurs because the immune system mistakenly identifies proteins in nightshade plants as harmful, triggering the release of histamine and other inflammatory chemicals that cause symptoms ranging from mild skin reactions to potentially life-threatening anaphylaxis. In severe reactions, an epinephrine auto-injector (EpiPen) should be used immediately if experiencing throat tightness, difficulty breathing, or severe swelling, followed by emergency medical attention, as recommended by the latest guidelines 1.

From the FDA Drug Label

1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.

The management and treatment options for a nightshade allergy include emergency treatment with epinephrine (IM) for anaphylaxis, which may result from allergic reactions to foods, including nightshades. The signs and symptoms associated with anaphylaxis include:

• Flushing
• Apprehension
• Syncope
• Tachycardia
• Thready or unobtainable pulse associated with hypotension
• Convulsions
• Vomiting
• Diarrhea and abdominal cramps
• Involuntary voiding
• Airway swelling
• Laryngospasm
• Bronchospasm
• Pruritus
• Urticaria or angioedema
• Swelling of the eyelids, lips, and tongue 2

From the Research

Management and Treatment Options for Nightshade Allergy

• The management of a nightshade allergy largely remains the exclusion of the offending food(s) 3
• It is essential to ensure that individuals with a nightshade allergy consume a healthy, balanced diet and do not avoid food groups unnecessarily 3
• Oral immunotherapy is showing promise for refractory patients with IgE-mediated food allergies, including nightshade allergy 4
• Avoiding foods that trigger allergic reactions is crucial for total asthma control and better quality of life in individuals with coexisting asthma and food allergy 4

Nutritional Considerations

• Nightshades are a diverse range of crops with significant culinary, economic, and cultural importance, and their avoidance can be problematic from a nutritional perspective 5
• The diet of individuals with a nightshade allergy should be reviewed to ensure they are consuming a healthy, balanced diet 3
• Substitute foods for nightshades may not have comparable nutritional profiles, and adults may be susceptible to online promotion of extreme nutritional regimes that can be harmful 3

Diagnosis and Trigger Identification

• Cut-off values are very important for both specific IgE levels and skin-prick test when interpreting food allergy, including nightshade allergy 4
• Skin prick test on non-atopic subjects using raw and cooked eggplant extracts revealed that only subjects with a lower threshold for histamine produce positive results 6
• The amount of histamine present in eggplant does not produce a positive SPT response in a majority of non-atopic subjects, and a positive response in a few subjects may be misdiagnosed as eggplant allergy 6

Associated Health Risks

• Nightshade-derived glycoalkaloid compounds can disrupt intestinal epithelium and potentially activate mast cells in the gut mucosa, leading to adverse symptoms in humans 5
• Mast cell activation is an allergic inflammatory mechanism contributing to pain in irritable bowel syndrome (IBS) and to gut inflammation in inflammatory bowel disease (IBD) 5
• Dietary nicotine intake from nightshades may contribute to the level of nicotine metabolites in biological fluids, although the mean daily dietary nicotine intake is estimated to be relatively low 7