Broccoli

The dosage for Broccoli allergenic extract is not a standard 'mg' amount but is instead based on volume and concentration used during diagnostic procedures. For Percutaneous Testing (Skin Prick Test), a single drop of the 1:10 or 1:20 w/v glycerinated extract is applied to the skin. The skin is then pricked through the drop using a sterile lancet. For Intradermal Testing, the concentration is significantly more dilute (often 1:100 to 1:1000 w/v), and approximately 0.02 mL to 0.05 mL is injected into the dermis to create a small bleb (blister).

Broccoli extract is generally considered safe for use in children when administered by a specialist. The dosage (volume) is identical to the adult dose; however, the number of simultaneous skin tests may be limited in very young children to minimize discomfort and the cumulative risk of a systemic reaction. Clinical judgment is required for infants under 6 months of age, as their skin reactivity may be diminished.

Renal Impairment

No dosage adjustments are required for patients with kidney disease, as the systemic exposure to the extract is minimal and the proteins are not primarily cleared by the kidneys in their active form.

Hepatic Impairment

No dosage adjustments are required for patients with liver disease. The metabolism of allergenic proteins does not rely on hepatic function.

Elderly Patients

Elderly patients may exhibit reduced skin reactivity (smaller wheal and flare responses) due to age-related changes in skin physiology and mast cell density. Healthcare providers may need to interpret results more cautiously or consider the use of positive controls (histamine) to ensure the skin is capable of reacting.

Broccoli extract is never 'taken' by the patient in the traditional sense; it is administered by a healthcare professional.

1. 1Site Selection: Testing is usually performed on the inner forearm or the upper back. The skin must be clean and free of rashes or dermatitis.
2. 2Controls: A positive control (histamine) and a negative control (saline or glycerin) must be administered alongside the Broccoli extract to ensure the validity of the test.
3. 3Observation: The patient must remain in the clinical setting for at least 20 to 30 minutes after administration. This is the critical window for both reading the test results and monitoring for signs of anaphylaxis.
4. 4Storage: The extract must be stored in a refrigerator at 2°C to 8°C (36°F to 46°F). Freezing must be avoided as it can denature the allergenic proteins, rendering the test inaccurate.

As this is a diagnostic tool used during a scheduled clinical visit, 'missed doses' do not occur in the same way as daily medications. If a testing appointment is missed, it should be rescheduled. If a test result is equivocal, the provider may choose to repeat the test at a later date or use a different concentration.

An 'overdose' in the context of allergenic extracts refers to the administration of too much antigen or an inappropriately high concentration, which can trigger a systemic allergic reaction or anaphylaxis.

• Signs of Overdose/Systemic Reaction: Generalized itching, hives (urticaria), swelling of the lips or throat, wheezing, shortness of breath, or a drop in blood pressure (fainting).
• Emergency Measures: If a systemic reaction occurs, the immediate administration of epinephrine (1:1000) is the first-line treatment. Oxygen, intravenous fluids, and antihistamines may also be administered by the clinical team.

> Important: Follow your healthcare provider's instructions regarding the discontinuation of antihistamines prior to testing. Do not attempt to use clinical extracts at home.

The most frequent side effects of Broccoli allergenic extract are localized to the site of testing and are, in fact, the intended diagnostic result. These include:

• Pruritus (Itching): Intense itching at the site of the prick or injection is very common and usually subsides within 30 to 60 minutes.
• Erythema (Redness): A red 'flare' around the test site is expected in sensitized individuals.
• Wheal Formation: A raised, pale bump resembling a mosquito bite. While diagnostic, large wheals can be uncomfortable.
• Local Irritation: A mild burning sensation upon application, especially with glycerinated extracts.

• Persistent Swelling: In some patients, the swelling at the test site may last for several hours or even up to 24 hours (a 'late-phase' local reaction).
• Lymphangitis: Rarely, red streaks may appear extending from the test site, indicating temporary inflammation of the lymph vessels.
• Fatigue: Some patients report feeling unusually tired after a battery of skin tests, likely due to the body's inflammatory response.

• Vasovagal Response: Fainting or lightheadedness due to the anxiety of needles or the testing procedure, rather than the extract itself.
• Infection: As with any procedure that breaks the skin, there is a very small risk of localized infection (cellulitis) at the prick site.

While rare during skin testing, systemic reactions are the most serious risk associated with Broccoli extract.

> Warning: Stop the procedure and call for emergency assistance if you experience any of the following symptoms during or shortly after testing:

• Anaphylaxis: A life-threatening, whole-body allergic reaction. It often begins with a sense of 'impending doom,' followed by rapidly progressing symptoms.
• Angioedema: Deep tissue swelling, particularly of the face, eyelids, lips, or tongue, which can obstruct the airway.
• Bronchospasm: Tightness in the chest, audible wheezing, or difficulty breathing as the airways constrict.
• Hypotension: A sharp drop in blood pressure leading to dizziness, confusion, or loss of consciousness.
• Generalized Urticaria: Hives spreading to areas of the body far from the original test site.

There are no known long-term side effects associated with the one-time diagnostic use of Broccoli allergenic extract. It does not accumulate in the body, and it does not cause permanent changes to the immune system. Repeated testing over many years is generally safe, provided the patient has not developed an increased sensitivity that might predispose them to systemic reactions.

No FDA black box warnings for Broccoli allergenic extract. However, most allergenic extracts carry a general class warning regarding the risk of severe systemic reactions and the requirement that they only be administered by clinicians prepared to manage anaphylaxis.

Report any unusual or persistent symptoms to your healthcare provider immediately. If symptoms occur after you have left the clinic, seek emergency care or use an epinephrine auto-injector if one was prescribed to you.

Broccoli allergenic extract is intended solely for diagnostic use and should never be ingested or used for self-treatment. The most critical safety consideration is the potential for an IgE-mediated systemic reaction. Patients must be screened for current health status, particularly respiratory stability, before testing begins. The presence of active asthma symptoms significantly increases the risk of a severe reaction to skin testing.

No FDA black box warnings for Broccoli. However, the standard of care dictates that these products be used only in settings where emergency resuscitative equipment and personnel trained in treating anaphylaxis are immediately available.

• Anaphylaxis Risk: Patients with a history of extremely high sensitivity to other Brassicaceae (like mustard) may be at increased risk. The healthcare provider may use more dilute solutions for initial testing in these individuals.
• Beta-Blocker Interference: Patients taking beta-blockers (medications for blood pressure or heart conditions) may be resistant to the effects of epinephrine if an emergency occurs. This makes any systemic reaction much more difficult to treat.
• ACE Inhibitor Risk: Similar to beta-blockers, ACE inhibitors may increase the severity of an allergic reaction or interfere with recovery.
• Skin Conditions: Testing should not be performed on skin affected by active eczema, psoriasis, or severe dermographism (a condition where light scratches cause hives), as these can produce false-positive results.

There are no long-term lab tests required for the use of Broccoli extract. However, during the procedure, the following monitoring is standard:

• Visual Observation: Continuous monitoring for 20-30 minutes post-test.
• Vital Signs: In patients at high risk, blood pressure and heart rate may be checked before and after testing.
• Lung Function: For patients with asthma, a peak flow or spirometry test may be performed prior to testing to ensure they are at their baseline respiratory health.

Broccoli extract generally does not affect the ability to drive or operate machinery. However, if a patient experiences a vasovagal response (fainting) or a systemic reaction requiring medication like antihistamines (which can cause drowsiness), they should not drive until they are fully recovered and the effects of any emergency medications have worn off.

There is no direct interaction between Broccoli extract and alcohol. However, alcohol consumption can cause vasodilation and may theoretically enhance the skin's reactivity or worsen a systemic allergic reaction. It is generally advised to avoid alcohol for 24 hours before and after allergy testing.

As a diagnostic test, there is no 'discontinuation' or tapering required. However, the most important 'discontinuation' involves antihistamines. Patients must stop taking H1-antagonists (like loratadine, cetirizine, or diphenhydramine) for 3 to 7 days prior to testing, as these drugs will block the wheal and flare response, leading to a false-negative result.

> Important: Discuss all your medical conditions, especially heart or lung problems, with your healthcare provider before starting Broccoli extract testing.

There are no drugs that are strictly contraindicated in the sense of causing a chemical incompatibility; however, certain drugs make the procedure of testing unacceptably dangerous:

• Beta-Blockers (e.g., Propranolol, Atenolol): These are considered a relative contraindication for allergy testing. If the patient has a severe reaction to the Broccoli extract, the beta-blocker will prevent epinephrine from working effectively, which could lead to a fatal outcome.

• ACE Inhibitors (e.g., Lisinopril, Enalapril): These medications can interfere with the body's natural ability to degrade bradykinin, potentially making an allergic reaction more severe or prolonged.
• Tricyclic Antidepressants (TCAs) (e.g., Amitriptyline): These can potentate the effects of epinephrine if it is needed for an emergency, but they can also have antihistamine-like effects that interfere with the test results.

• H1 Antihistamines: Drugs like cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) will suppress the skin's response to the Broccoli extract. This results in a false-negative test. These must be stopped several days before testing.
• H2 Antihistamines: Drugs like famotidine (Pepcid) can also slightly reduce the skin reaction and should ideally be discontinued 48 hours before testing.
• Systemic Corticosteroids: Long-term use of high-dose prednisone may thin the skin or slightly reduce reactivity, though short-term use often does not interfere with skin prick testing as much as antihistamines do.
• Topical Corticosteroids: Applying steroid creams to the test site will suppress the local immune response and must be avoided for at least 2-3 weeks on the specific area being tested.

• Cross-Reactive Foods: Patients allergic to broccoli may also react to other members of the Brassica genus, such as cabbage, cauliflower, Brussels sprouts, and mustard. Eating these foods shortly before a test might theoretically prime the immune system, though this is not a standard contraindication.
• High-Fat Meals: No known interaction with the diagnostic extract.

• High-Dose Vitamin C: Some studies suggest Vitamin C has mild antihistamine properties, which could theoretically diminish the wheal and flare response.
• Astragalus or Echinacea: These immune-modulating herbs could theoretically alter skin reactivity, though clinical data is lacking.

Broccoli extract testing does not interfere with standard blood work (CBC, metabolic panels). However, the presence of the extract in the skin will obviously interfere with any other skin-based tests being performed simultaneously in the same area.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, especially those for blood pressure or allergies.

Broccoli allergenic extract must NEVER be used in the following circumstances:

• Recent Systemic Allergic Reaction: If a patient has experienced anaphylaxis from any cause within the last 2-4 weeks, their immune system may be in a 'refractory' state, or they may be hyper-reactive, making testing dangerous or inaccurate.
• Severe, Uncontrolled Asthma: Patients with a Forced Expiratory Volume (FEV1) of less than 70% of predicted are at high risk for fatal bronchospasm if a systemic reaction occurs during testing.
• Dermatographism: Patients whose skin wheals up in response to any touch or pressure cannot be tested accurately, as every 'prick' will look like a positive reaction regardless of the allergen.
• Active Skin Disease at Test Site: Testing on skin with active eczema, infection, or burns is contraindicated as it prevents accurate reading and risks infection spread.

• Pregnancy: While not strictly contraindicated, testing is usually deferred until after delivery to avoid the risk (however small) of systemic reactions that could cause fetal distress.
• Beta-Blocker Therapy: Requires a careful risk-benefit analysis by the physician.
• Infants and Very Elderly: Due to potentially unreliable skin reactivity.

Patients should be screened for known allergies to:

• Mustard Seeds: Often the primary allergen in the Brassicaceae family.
• Mugwort Pollen: Known for the 'Mugwort-Mustard-Broccoli' cross-reactivity syndrome.
• Other Cruciferous Vegetables: Cabbage, Kale, and Cauliflower.

> Important: Your healthcare provider will evaluate your complete medical history before prescribing Broccoli extract testing.

Broccoli extract is classified as FDA Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. The primary concern is not the extract itself, but the potential for a systemic reaction (anaphylaxis) in the mother, which can lead to uterine contractions, placental hypoperfusion (reduced blood flow), and fetal hypoxia (lack of oxygen). Consequently, most allergists recommend postponing diagnostic skin testing until after the pregnancy is completed, unless the information is critical for immediate management.

It is not known whether the minute amounts of protein in Broccoli extract pass into breast milk. However, given the localized nature of skin testing and the extremely small quantities used, it is highly unlikely to affect a nursing infant. The risk-benefit ratio is generally favorable for breastfeeding mothers.

Skin testing with Broccoli extract is approved for use in the pediatric population. It is a vital tool for identifying food allergies that may be contributing to atopic dermatitis (eczema) or gastrointestinal issues in children. Special care should be taken with children who have a history of severe asthma. For very young children, the 'multi-test' devices are often preferred to minimize the time and stress of the procedure.

In patients over 65, the skin often becomes thinner and loses elasticity. This can result in a decreased mast cell response, leading to smaller wheal sizes. Physicians should use a histamine control to ensure the patient's skin is still reactive. Additionally, the prevalence of cardiovascular disease and the use of beta-blockers in this population require extra caution during testing.

No adjustments are needed. The diagnostic use of allergenic extracts has not been shown to be affected by or to affect renal function.

No adjustments are needed. Liver function does not play a role in the localized IgE-mediated response required for this test.

> Important: Special populations require individualized medical assessment by an allergy specialist.

Broccoli allergenic extract works by eliciting a Type I Hypersensitivity Reaction. The extract contains specific proteins (antigens), such as Bra o 1 (a 2S albumin) and other lipid transfer proteins (LTPs), which are known allergens in the Brassica genus. Upon percutaneous introduction, these antigens bind to pre-sensitized IgE antibodies on the surface of cutaneous mast cells. This binding causes the IgE receptors (FcεRI) to cluster, signaling the mast cell to release pre-formed mediators like histamine and heparin, and to synthesize new mediators like leukotrienes. This results in localized capillary leak (wheal) and vasodilation (flare).

• Onset of Action: The wheal and flare response typically begins within 5 minutes of administration.
• Peak Effect: The reaction reaches its maximum size between 15 and 20 minutes.
• Duration: The visible reaction usually fades within 1 to 2 hours, although late-phase reactions (mediated by eosinophils and T-cells) can occur 4 to 8 hours later in highly sensitive individuals.

| Parameter | Value |

|---|---|

| Bioavailability | Negligible (Local administration) |

| Protein Binding | N/A (Local action) |

| Half-life | < 30 minutes (Histamine mediators) |

| Tmax | 15-20 minutes (Diagnostic response) |

| Metabolism | Local Proteolysis |

| Excretion | Lymphatic clearance of fragments |

• Molecular Components: A complex mixture of proteins, glycoproteins, and polysaccharides derived from Brassica oleracea var. italica.
• Solubility: Soluble in aqueous buffers and 50% glycerin solutions.
• Formulation: Usually standardized by Weight/Volume (w/v) or Protein Nitrogen Units (PNU). 1 mg of protein nitrogen is equivalent to 100,000 PNU.

Broccoli extract is classified as a Non-Standardized Food Allergenic Extract. It is part of a broader therapeutic and diagnostic group that includes other vegetable, fruit, and nut extracts used for allergy identification. It is distinct from 'Standardized' extracts like those for Ragweed or Honey Bee Venom, which have specific potency requirements defined by the FDA.