Study Suggests High Degree Of Sensitization, Severe Reaction To Other Legumes In Children With Peanut Allergies

There is a high prevalence of allergic sensitization to other legumes in children with peanut allergies (PA), new research suggests.

The most common allergic reaction trigger for children is food allergens. In France, where the study took place, legume consumption has increased over the past 20 years and is responsible for 14.6% of food-related anaphylaxis for children.

Although legume production is increasing worldwide due to health benefits, legumes such as lentils, peas, soy, beans, lupine and fenugreek are major causative agents of allergic reactions and remain unlisted in 14 priority food allergens.

The study, led by Timé Muller and Amandine Luc, sought “first to determine the prevalence of sensitization and allergy to other legumes in children with PA and second to determine the severity of these allergic reactions.”

Research and Methods

Muller and colleagues recruited 195 study participants from France’s Nancy University Hospital in the Pediatric Allergy Department, with recruits having been admitted due to PA diagnosis from January 2017 to February 2020. Those under 1 year old and over 17 years by the time of diagnosis were excluded from the research.

The investigators defined PA in two ways: either a positive oral food challenge (OFC) to peanuts or a history of allergy associated with peanuts. They collected the patients’ data from medical records retrospectively, and parents of children undergoing OFC received notice and gave written consent to data use.

The patients’ variables collected by the research team included the following:

• Demographic and social characteristics.
• PA history.
• Atopic comorbidities.
• Legume co-sensitization or coallergy, including OFC, skin prick test (SPT), prior reaction, specific immunoglobulin E (sIgE).

Data gathered from previous allergic reactions was collected when there was a lack of OFC data to determine severity. By analyzing consumption, sensitization, and allergic reaction, the patients’ allergic status to every legume included was able to be evaluated by the investigators.

Study Results

The investigators found in their research that 98.4% had at least 1 other atopic disease, and 69.7% of patients were male. They also found that 62.4% of the 195 PA patients had other food allergies, most common being pistachio (N = 28, 23.7%), egg (N = 68, 57.6%), cashew nut (N = 46, 39.0%), cow's milk (N = 39, 33.0%), and hazelnut (N = 36, 30.5%).

The investigators found that overall, among the 191 children with data relating to legume sensitization, at least one legume sensitization was present in about 64%. They also found that an allergy to ≥1 legume was observed in 34 patients.

Sensitization among the children were found by the research team to mainly be lentil, fenugreek, lupine, and soy. Within the sensitized group, pea, lupine, and lentil were the primary allergens, with anaphylaxis frequent for those affected by soy and lentil.

The researchers added that because allergies to legumes other than peanuts frequently led to anaphylactic reactions in patients, a targeted allergy assessment may be necessary due to the severity of reactions like these.

“The high prevalence of legume sensitization reported in our study highlights the need to explore legume consumption in children with PA, and the need to investigate sensitization in the absence of consumption,” they wrote.

This study, “Relevance of sensitization to legumes in peanut-allergic children,” was published on Pediatric Allergy and Immunology online.