The frequency of pea allergy varies among different populations. Legume allergy, mainly to lentils and chickpeas, is the fifth most common cause of food allergy in Spanish children.
Cross-reactivity between peanut allergy and pea allergy is relatively common. Please review the text below for a detailed description.
Legumes and lentils
Peanuts and soybeans are the major legumes involved in human food allergy. Fewer data exist on adverse reactions to other temperate legumes, such as lentils.
Lentils, chickpeas, beans, and peas are the most common consumed legumes in the Mediterranean area.
Allergic reactions to lentils started early in life, usually below 4 years of age; oropharyngeal symptoms and acute urticaria were the most common symptoms through ingestion, and symptomatic reactivity to chick peas is frequently associated.
Sensitization to lupine is common peanut-sensitized adults
The use of lupine in food has been increasing during the last decade and allergic reactions to lupine have been reported, especially in peanut-allergic patients.
39 peanut-sensitized patients were evaluated by skin prick tests (SPT) and ImmunoCAP to lupine, pea, and soy (Peeters KA et al, Allergy. 2009). Clinical reactivity was measured by double-blind placebo-controlled food challenges (DBPCFC) for lupine, and by history for pea and soy. None of the patients was aware of the use of lupine in food.
82% of patients were sensitized to lupine, 55% to pea, and 87% to soy. Clinically relevant sensitization to lupine, pea, or soy occurred in 35%, 29%, and 33% respectively.
The lowest eliciting dose (ED) for lupine, inducing mild subjective symptoms, was 0.5 mg.
In this study (Peeters KA et al, Allergy. 2009), peanut-sensitized patients, clinically relevant sensitization to either lupine or to pea or soy occurs frequently. The ED for lupine is low (0.5 mg), which is only fivefold higher than for peanut.
Cross-reactivity between legumes is common
Serological cross-reactivity among legumes is frequent, but its clinical relevance is controversial. In Spanish study (Martínez San Ireneo M et al, Int Arch Allergy Immunol. 2008), the cross-reactivity among lentils, chickpeas, peas, white beans and peanuts and its clinical relevance was investigated in 54 pediatric patients. All children had a clinical allergy to legumes. Cross-reactivity was evaluated by ELISA inhibition experiments and oral food challenges to legumes.
ELISA inhibition demonstrated more than 80% inhibition with lentil, chickpea and pea extracts. The oral legume challenges demonstrated that 69% of children were allergic to 2 or more legumes (median 3 legumes).
The most frequent associations were allergy to lentils and chickpeas (57%), allergy to lentils and peas (54%) and allergy to lentils, chickpeas and peas (43%).
In vitro inhibition demonstrated a high degree of cross-reactivity among lentils, chickpeas and peas. Food challenges confirmed that clinical allergy to all three legumes is frequent.
Clinical features of legume allergy in children from a Mediterranean area. Martínez San Ireneo M, Ibáñez MD, Sánchez JJ, Carnés J, Fernández-Caldas E. Ann Allergy Asthma Immunol. 2008 Aug;101(2):179-84.
In vitro and in vivo cross-reactivity studies of legume allergy in a Mediterranean population. Martínez San Ireneo M, Ibáñez MD, Fernández-Caldas E, Carnés J. Int Arch Allergy Immunol. 2008;147(3):222-30. Epub 2008 Jul 2.
Vicilin and convicilin are potential major allergens from pea. R. Sanchez-Monge et al. Clinical & Experimental Allergy, Volume 34 Issue 11, Pages 1747 - 1753, 2004.
Allergy to lentils in Mediterranean pediatric patients. Pascual CY et al. J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):154-8.
Clinical relevance of sensitization to lupine in peanut-sensitized adults. Peeters KA, Koppelman SJ, Penninks AH, Lebens A, Bruijnzeel-Koomen CA, Hefle SL, Taylor SL, van Hoffen E, Knulst AC. Allergy. 2009 Apr;64(4):549-55. Epub 2008 Dec 4.