Figueroa et al. (2005) [1162] report that the symptoms of 38 patients consisted of OAS in 18 cases (47.4%), urticaria/angioedema in 16 (42.1%), and systemic anaphylaxis in four (10.5%). One case of anaphylaxis was mustard-dependent exercise-induced anaphylaxis.

Morisset et al. (2003) [602] found in a group of 30 patients that 24 had atopic dermatitis, 15 asthma, 6 angioedema, 2 digestive symptoms, and 1 with abdominal pain.

Caballero et al. (2002) [648] found in a group of 29 patients that 16 had angioedema, 11 dyspnea, 10 general urticaria, 8 oral allergy syndrome, 5 gastric symptoms, 5 dysphonia, 4 conjunctivitis, 3 rhinitis, 2 loss of consciousness, 2 dysphagia and 2 general puritus.

Rance et al. 2000 [482] found in a group of 36 patients that 28 had atopic dermatitis, 20 urticaria and/or angioedema, 5 asthma, and 1 laryngeal edema with oral allergy syndrome and rhinoconjunctivitis. No anaphylaxis was observed.

Rance et al. 1999 [483] found in a group of 49 patients that 21 had atopic dermatitis, 21 urticaria and/or angioedema, 2 asthma, 1 anaphylaxis, 1 gastrointestinal symptoms, 1 oral allergy syndrome and 2 conjunctivitis.

Dominguez et al. 1990 [1158] reported 7 patients with angioedema, urticaria or anaphylactic shock.

Other authors comment on the severity of the symptoms resulting from ingestion or contact with mustard (Jorro et al. 1995 [373], Kanny et al. 1995 [377], André et al. 1994 [262], Malet et al. 1993 [409], Monreal et al 1992 [423], Panconesi et al. 1980 [452]) which frequently need urgent hospital treatment. Many authors state that the severity of symptoms did not allow oral provocation studies.

Figueroa et al. (2005) [1162] used prick-prick with the mustard sauce used for oral challenge and commercial extracts of mustard, other foods and pollens.

Ground mustard seeds (Brassica nigra), mustard flour (B. juncea), metabisulfite-free strong mustard seasoning (B. juncea) and a commercialized allergenic extract (B. nigra) were used by Morisset et al. 2003 [602].

Fresh extracts of mustard-seed powder were used by Rance et al. 2000 [482].

Histamine dihydrochloride (10mg/ml) and physiologic saline solutions served as positive and negative controls, respectively. A mean wheal diameter >3mm, compared with the saline control, was considered a positive response (Figueroa et al. 2005) [1162] .

The positive control was 9% codeine sulfate. Prick-in-prick tests were performed with 25 natural foods. The positive criterion was a wheal diameter of more than or equal to the 9% codeine phosphate control (Morisset et al. (2003) [602]).

Figueroa et al. (2005) [1162] tested 38 patients.
Caballero et al. (2002) [648] reported 29 patients.
Rance et al. 2000 [482] reported SPT on 3600 patients.

Figueroa et al. (2005) [1162] report that mustard SPT was positive in all patients, with a wheal (mean ± SD) of 6.7 ± 3.6 mm, being negative in all control subjects. After DBPCFC, it was possible to find a statistically significant difference (P < 0.05) when comparing commercial mustard extract SPT results between truly allergic patients (positive DBPCFC, 8.2±3.7) and sensitized patients (negative DBPCFC, 5.3±2.4mm). The best cut-off value for mustard commercial SPT was 8mm, with a specificity of 90% (95% CI, 55.5-98.3), and a sensitivity of 50% (95% CI, 23.1-76.9) for predicting a positive challenge outcome.

Morisset et al. (2003) [602] report 30 positive SPT tests of whom only 7/30 predicted a positive oral challenge.

Caballero et al. (2002) [648] report 100% positive SPT.

Rance et al. 2000 [482] reported 36 positive SPT from 3600 patients or 1%.

11 (Monsalve et al. 1993 [121] )
49 (Rance et al.1999 [483])
29 (Caballero et al. (2002) [648])
27 (Morisset et al. 2003 [602]).

Figueroa et al. (2005) [1162] reported a positive CAP result for specific IgE to mustard in 35 patients (92.1%), with a geometric mean of 1.7 kU/l, ranging from <0.35 to 24.0 kU/l. Controls were negative.

The mean of mustard specific-IgE values was 8.7 kU/l (0.35-72.4) from <0.35 to 72.4. However, the highest IgE was negative by DBPCFC (Morisset et al. 2003 [602]).

The 11 patients of Monsalve et al. 1993 [121] had RAST scores of 3-4.

A commercial yellow mustard sauce was masked in a natural yoghurt-based vehicle, containing a mix of vanilla and lemon juices, sugar and yellow colouring. Mustard sauce was composed of water, S. alba seeds (14% w/v), vinegar, salt, turmeric, paprika and cloves, and it was free of sulphites (Figueroa et al. 2005) [1162].

A sweet cold drink such as Coca Cola to which the mustard was added immediately before use (Morisset et al. 2003 [602]).

Fresh mustard seeds extracts (Rance and Dutau, 1997 [481]; Rance et al., 2000 [482]).

Figueroa et al. (2005) [1162] used double blind challenges.

Morisset et al. (2003) [602] used both double and single blind challenges.

Rance et al. (2000) [482] used only single blind challenges.

Rance and Dutau (1997) [481] and Rance et al. (1999) [483] used single blind challenges and the Labial Food Challenge.

24 DBPCFC (Figueroa et al. 2005) [1162]

24 DBPCFC and 6 SBPCFC (Morisset et al. 2003 [602])

36 children, average age 5.5 (Rance et al. 2000 [482])

23 patients (Rance and Dutau 1997 [481])

Increasing doses of the sauce (80, 240, 800, 2400 and 6480 mg) were administered with a 15-min interval until symptoms appeared or a cumulative dose of 10g of mustard sauce was reached (Figueroa et al. 2005) [1162]. 7 patients reacted to 44.4mg., 6 to 156.8mg. and 1 to 492.8mg. of mustard (44.4mg mustard is 320mg of the sauce). No significant relation with mustard SPT or specific IgE could be demonstrated.

Increasing doses (10, 30, 100, 300, and 900 mg) were administered every 20 min to a cumulative dose of 1340 mg (Morisset et al. (2003) [602]). One patient reacted to 40 mg but some of the seven positives occured after the last dose.

Rance et al (2000) [482] carried out SBPCFC (single blind placebo controlled food challenge) on 36 children who were SPT positive to mustard. They observe that the mean cumulative dose of mustard that could trigger a reaction was 153mg.

14/24 DBPCFC were positive with 11 patients showing oral allergy syndrome symptoms (1 with conjunctivitis), 1 patient with angioedema and bronchial asthma, 1 patient with urticaria and 1 anaphylaxis (Figueroa et al. 2005) [1162].

Seven SBPCFC or DBPCFC were positive (eczema, conjunctivitis, abdominal pain and diarrhea, palpebral pruritus, sneezing and erythema, wheezing) (Morisset et al. 2003 [602]).

Rance et al. 2000 [482] reported that 15/36 children gave a positive challenge. Symptoms observed during the SBPCFC were urticaria (14 cases), rhinoconjunctivitis (three cases), angiodema (one case), oral allergy syndrome (one case), and eczema (one case).

Labial Food Challenge, single-blind placebo-controlled food challenge and/or skin prick testing was used to confirm allergy to mustard in 49 children (Rance and Dutau, 1997 [481]; Rance et al., 1999 [483]). In the Labial Food Challenge allergen extracts were placed on the lower lip for 2 minutes. The result was read 30 minutes later. A score of 3 or higher was considered positive. The scores given according to symptoms were: 1.- smoothing of the lower lip; 2.- erythema under the lip; 3.- contiguous rash of the cheek and chin; 4.- edema of the lip with rhinitis and conjunctivitis; 5.- systemic reaction. Patients with negative LFC were investigated by single-blind, placebo-controlled food challenge.