Gingerbreads, the Christmas allergen bomb

According to historical accounts, the first known recipe for gingerbread comes from Greece. It was created around 2400 BC. [2]. It is believed that the art of gingerbread baking – in 992 – was taught to Christian bakers by the Armenian monk Gregory of Nicopolis. [2] Although the oldest recipe to be found in English cookbooks dates to the mid-15th century [5,7].

The court of Queen Elizabeth I was particularly famous for its gingerbread in various shapes. The royal gingerbread maker baked biscuits featuring the portraits of dignitaries and important guests – this was even mentioned by Shakespeare [2]. Hence the traditional shape of the gingerbread man. In the Elizabethan era, gingerbread was regarded as a cake to improve digestion and was always served at the end of a meal [7]. In the following centuries, gingerbread became popular throughout Europe. They were used as window decorations or given as gifts to celebrate religious occasions or birthdays [2]. Gingerbread houses gained popularity at the beginning of the 19th century after the Brothers Grimm published Hansel and Gretel [6]. Since then, they have become an integral culinary element of Christmas [7].

Today, the recipes for gingerbread are endless – as are the ingredients that can be found in these traditional cakes. The most common ingredients in gingerbread cookies are flour, egg, butter, oil, milk, honey or sugar, cinnamon, ginger, nutmeg, cloves and cocoa. Natural yoghurt, cream or buttermilk, baking powder, baking soda are also added to gingerbread cookies. The biscuits in the spicy version are strongly spiced: white pepper, cayenne pepper, chilli, saffron, aniseed, ground allspice and coriander seeds. Some recipes additionally feature flaked almonds, oatmeal, candied lemon peel and even rum or vodka [3,7].

For a very long time, the ingredients in gingerbread were unavailable to the majority of the people. It was therefore considered a delicacy that could only be eaten on holidays. Gingerbread was mainly associated with Christmas markets, where it was eaten “for luck” [7].

Basically, any ingredient found in traditional Christmas cakes can be the cause of an allergic reaction. So, let’s take a look at the main allergens in gingerbread.

Gingerbread allergens: egg

Egg belongs to the so-called ‘big eight’ food allergens that are responsible for the largest number of such allergies worldwide. According to World Health Organisation experts, it ranks second in the ‘eight’ in terms of the frequency of allergic reactions [9]. The main, very potent egg allergens are two proteins: ovomucoid and ovalbumin [10]. However, a total of 25 and even 40 different allergenic proteins are indicated. An allergic person, after eating an egg, may notice such allergy manifestations as:

• acute gastrointestinal complaints (vomiting, abdominal pain, diarrhoea),
• eczema on the skin,
• urticaria,
• rhinitis,
• asthma,
• anaphylactic shock [10].

The egg content in gingerbread, however, will not always cause symptoms in an allergic person. Why? Because some (thermolabile) allergens lose their allergenic properties after heat treatment [10]. A study has been published in which 20% of subjects showed a reaction only to raw egg [10,13]. At the same time, there is a group of allergy sufferers who cannot tolerate contact with egg in any form [10]. These should choose gingerbread recipes without this ingredient.

Gingerbread allergens: milk and dairy products

In the “big eight,” preceding the egg, only milk (and its derivatives: cream, yogurt, butter, buttermilk, etc.) is found, which is the main cause of food allergies [9]. It can even trigger a multi-organ allergic reaction, including anaphylaxis [11]. Symptoms of milk allergy are usually immediate (from a few minutes to 2 hours after consumption). Less commonly, they occur within 6–12 hours or later. In cow’s milk, 20–30 proteins that can cause allergies have been identified. The two primary fractions are caseins and whey proteins [11].

Does this mean that individuals with a cow’s milk protein allergy should not try gingerbread with a milk-based composition? Like in the case of eggs – not always. Some proteins, after prolonged exposure to high temperatures, reduce their allergenicity. Therefore, bakery products, including gingerbread, may be tolerated by a certain group of individuals with allergies [11]. However, with confirmed cow’s milk protein allergy, one must exercise extreme caution with culinary experiments.

Gingerbread allergens: wheat flour

Wheat flour contained in baked goods is a product to be avoided not only by people with coeliac disease, but also by some allergy sufferers. The source of the problem here is not just the notorious gluten. It is also possible to be allergic to non-gluten wheat proteins (this is – against all odds – more commonly diagnosed) [12]. So far, almost 30 allergens present in this most popular and most allergenic cereal in Poland have been detected [12,14,16]. Of importance are e.g. Tri a 1 (expansin), Tri a 12 (profilin), Tri a 14 (nsLTP) [14].

Allergy to wheat and wheat products, including gluten, as a classic IgE-dependent food allergy [12], is associated with the occurrence of symptoms:

• Skin-related (contact urticaria),
• Gastrointestinal (oral allergy syndrome, vomiting, diarrhea, constipation, bloating),
• Respiratory (rhinitis, the so-called baker’s asthma),
• Generalized (exercise-induced anaphylaxis) [12,14].

The severity of these symptoms varies between allergic individuals [12]. Unlike in the case of coeliac disease – some allergy sufferers may consume small amounts of gluten and not experience any discomfort. It is important to remember that allergy and gluten sensitivity are two separate problems [12]. Although they may have a similar course [14].

So what to use instead of wheat flour? The answer is not simple and depends on the individual allergy sufferer’s situation. Naturally gluten-free cereals include amaranth, buckwheat, maize, millet, quinoa, teff and rice. However, not all of them can be alternatives for people with wheat allergy [15]. The possibility of cross-reactions must be taken into account. Wheat (specifically the LTP present in it) cross-reacts with rice (i.e. Ory s 14 protein) and corn (i.e. Zea m 14 protein) [14].

Gingerbread allergens: spices

The popularity of gingerbread during the Christmas season is largely attributed to spicy seasonings with warming properties [7]. However, these spices can be quite deceptive as they belong to hidden allergens. They are not always labeled on the packaging of ready-made products [1], including store-bought gingerbread. Spices can also be a cause of allergic reactions when used in homemade baking. Many of them can cross-react [8].

According to estimates, spice allergy accounts for 2–4% of all food allergies [8]. Allergens derived from spices have not been thoroughly identified. For example, allergic reactions have been observed after consuming spices from the parsley family (such as anise and coriander) in individuals allergic to birch and ragweed pollen or celery [8]. It has also been noted that pepper, nutmeg, cinnamon, and ginger may trigger food allergy symptoms in individuals allergic to pollen from grassy plants [8]. As for cinnamon, commonly added to gingerbread, one can expect not only food allergies but also contact allergies. This occurs upon direct skin contact with cinnamon bark – in the form of a stick or powder [8].

Gingerbread allergens: honey

Honey also has allergenic properties and is on the list of allergens in gingerbread. It is a complex mixture of, among other things, flower nectar, pollen, propolis, wax and bee compounds (enzymes present in the secretions of the bees’ salivary and pharyngeal glands) [4]. The composition of honey depends on the season and the location of the hive in the plant environment [4]. The prevalence of honey allergy is not high compared to the global prevalence of this product. However, isolated cases of anaphylaxis after eating honey have been reported in the literature [4]. One study shows that three quarters of people with honey allergy are also allergic to pollen (mainly dandelion and ragweed) [4]. Some are additionally allergic to bee venom.

Symptoms of an allergic reaction to honey are:

• urticaria,
• rhinitis,
• angioedema,
• abdominal pain,
• diarrhoea.

Allergy sufferers (especially those sensitive to pollen) – for safety reasons – can replace the bee honey in the gingerbread cookies with sugar or another sweetener.

Aleksandra Lipiec 

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translation: Julia Majsiak