Cannabis sativa as a clinically relevant nsLTP allergen in the Mediterranean region: a case series exemplifying different possible routes of sensitization

Cannabis is the most widely used drug worldwide sought for recreational and medicinal purposes. Cannabis allergy was first described 50 years ago but has become more frequently reported over the past decade due to a larger industrial and domestic cultivation, and an evolving legal status. However, it remains an infrequent cause of allergy in the Mediterranean European countries. We describe three clinical cases with primary sensitization to cannabis characterized by anaphylactic reactions. We hypothesize that in all three case reports, sensitization to Can s 3 nsLTP played a crucial role in the development of anaphylaxis, either directly following ingestion of hemp-containing food, or even indirectly through primary sensitization via involuntary exposure or occupation exposure to cannabis sativa.