Carmine – overlooked allergen in diagnostic of immediate and delayed idiopathic hypersensitivity

Carmine (E120, Natural Red 4, color index no.75470) is a natural red dye extracted from the dried bodies of female cochineal insects used widely in food, cosmetics and pharmaceutical industries. Protein insect impurities in carmine can be responsible for allergic reactions. Over 80 cases of hypersensitivity have been reported after carmine ingestion, inhalation or contact. Anaphylactic reactions, urticarial and contact allergy have been occurred mostly in atopic female patients, whereas occupational asthma has been diagnosed among rather male patients after prolonged exposure. IgE-mediated hypersensitivity reactions can occur immediately or even few hours after carmine ingestion. Positive skin prick test reactions occur in about 3% of patients diagnosed for food allergy and can be simple diagnostic screening method indicating carmin hypersensitivity. Measurements of serum levels of specific IgE, basophil activation test, patch tests and oral/inhalation challenge are used in patient evaluation. No European standard methods for management with carmine hypersensitivity have been established.