Eosinophilia and gastrointestinal symptoms after ingestion of shiitake mushrooms,☆☆,,★★,

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Abstract

Background: Shiitake mushrooms are a dietary staple in Asia and are increasingly popular worldwide. A cholesterol-lowering study with shiitake showed that 17 of 49 participants withdrew because of rash or abdominal discomfort, and two had marked eosinophilia. One of these latter participants was subsequently challenged for 14 days with shiitake powder and again had eosinophilia. Objective: We investigated whether ingestion of shiitake mushroom powder induces eosinophilia or symptoms. Methods: We studied 10 normal persons. Each participant ingested 4 gm shiitake powder (open label) daily for 10 weeks (trial 1), and the protocol was repeated in these same subjects after 3 to 6 months (trial 2). Blood counts and serum samples were obtained biweekly (trial 1) or weekly along with stool specimens (trial 2). Eosinophil major basic protein and IL-5, IgE, and IgG antishiitake antibodies were measured in sera. Eosinophil-derived neurotoxin was measured in stool extracts. We defined responders as subjects having peak eosinophil counts four or more times their average baseline counts. Results: Each trial had four responders, and trial 2 had one new and three repeat responders. Eosinophilia ranged from 400 to 3900/mm3. Responders had increased blood eosinophils, serum major basic protein, stool eosinophil-derived neurotoxin, and factors that enhanced eosinophil viability. Antishiitake IgE was not detected, and antishiitake IgG increased in two responders. Gastrointestinal symptoms coincided with eosinophilia in two subjects. Symptoms and eosinophilia resolved after discontinuing shiitake ingestion. Conclusions: Daily ingestion of shiitake mushroom powder in five of 10 healthy persons provoked blood eosinophilia, increased eosinophil granule proteins in serum and stool, and increased gastrointestinal symptoms. Shiitake ingestion suggests a model to study the eosinophil's role in the blood and gastrointestinal tract. Finally, our report raises concerns of possible adverse systemic reactions to this increasingly popular food.(J Allergy Clin Immunol 1998;101:613-20.)

Section snippets

Challenge of index subject

During the cholesterol-lowering study, one subject, a 56-year-old man, had severe abdominal cramping prompting an emergency room evaluation that was remarkable for an eosinophilia of 9700/mm3. The challenge study in this index subject was conducted after his symptoms had resolved and his eosinophil counts had normalized. He ingested the same daily dose as that used in the cholesterol-lowering study, but with shiitake mushrooms from a different source. Imported dried shiitake mushrooms were

Challenge of index subject

While ingesting 4 gm shiitake powder daily for 14 days, the subject experienced mild abdominal discomfort (not severe discomfort as previously experienced in the cholesterol-lowering study), eosinophilia, and an elevated serum MBP level (Table I). By day 12, cytokines that enhance eosinophil viability were detected in the subject's serum (Table I). Four days after the last ingestion of shiitake powder, his symptoms had resolved. Seventeen days after the last shiitake ingestion,

Discussion

This is the first report of eosinophilia and gastrointestinal changes after shiitake mushroom ingestion. Other immunologic reactions associated with the shiitake mushroom have been described. These reactions have included contact dermatitis, generalized pruritus, and hypersensitivity pneumonitis.19, 20, 21 However, eosinophilia has not been associated with these findings, and in our study no participant experienced skin or lung symptoms.

Here we have demonstrated that a chance observation of

Acknowledgements

We thank Ms. Debbie Jacobson of the University of Colorado for the cholesterol-lowering study information, Mr. Richard Jones for the IgE antibody determinations, Mr. Mark Swanson for the IgG antibody determinations, Dr. Allan Zinsmeister for statistical advice, Ms. Diane Squillace for the MBP assays, Ms. Kathleen Bartemes for the EDN and eosinophil viability determinations, Ms. Sandra Dunnette and Mr. Louis Kost for preparation of graphic materials, Ms. Cheryl Adolphson for editorial

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  • Cited by (0)

    From athe Division of Gastroenterology and Hepatology and Internal Medicine and bthe Department of Immunology, Mayo Clinic and Mayo Foundation, Rochester; and cthe Fitzsimmons Army Medical Center, Denver.

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    Supported in part by grants from the National Institutes of Health (AI 15231, AI 09728, AI 34577, AI 34486, DK 07198, and DK 32121), the Mayo Foundation, and United States Army research funds.

    The opinions or assertions contained herein are the private views of the authors and are not to be construed as a reflection of the views of the Department of the Army or the Department of Defense.

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    Reprint requests: Gerald J. Gleich, MD, Department of Immunology, Mayo Clinic, Rochester, MN 55905.

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