Case of anaphylaxis caused by black ginger in a dietary supplement

Dear Editor, Black ginger (Kaempferia parviflora) has been used as a nourishing medicinal tonic in Thailand and has recently become a popular ingredient in dietary supplements in Japan. Herein, we report the first case of anaphylaxis caused by black ginger. Black ginger belongs to the family Zingiberaceae, which includes zedoary (Curcuma zedoaria), turmeric (Curcuma longa), wild turmeric (Curcuma aromatica) and ginger (Zingiber officinale). A 54-year-old woman was referred to our department with anaphylactic symptoms, including systemic urticaria, abdominal pain, nausea and dyspnea, which had started 2 h after intake of five kinds of dietary supplements. A skin prick test (SPT) yielded a positive result for Company A’s dietary supplement 1% aqua (aq.), while tests for other dietary supplements yielded negative results. SPT on the ingredients of Company A’s dietary supplement yielded a positive result for black ginger 1% aq., but negative results for the other five ingredients. Therefore, we diagnosed the patient with anaphylaxis caused by black ginger. She ate the causative supplement for the first time. Additionally, positive SPT results were obtained with 1% aq. of C. zedoaria, C. longa, Z. officinale and 10% aq. of C. aromatica. To identify the causative protein, we performed polyacrylamide gel electrophoresis (PAGE) and western blotting in both sodium dodecylsulfate PAGE (Fig. 1a) and 2D-PAGE (Fig. 1b), and identified the positive band at 35 kDa of black ginger. Mass spectrometric analysis using TripleTOF 6600 (ABSCIEX, Framingham, MA, USA) and PROTEINPILOT software version 5.0 (ABSCIEX) against entries in the National Center for Biotechnology Information (NCBI) nr database revealed that