Food and Drug Reactions and Anaphylaxis
Patients with anaphylaxis to pea can have peanut allergy caused by cross-reactive IgE to vicilin (Ara h 1),☆☆

https://doi.org/10.1067/mai.2003.61Get rights and content

Abstract

Background: Serologic cross-reactivity among legumes has been described; however, it is rarely clinically significant. In this study 3 patients with a history of anaphylaxis to pea are described who subsequently had symptoms after ingestion of peanut. Objective: We investigated whether the peanut-related symptoms were due to cross-reactivity between pea and peanut proteins. Methods: Peanut-related symptoms were documented according to case history or double-blind, placebo-controlled food challenge results. Skin prick tests were performed, and specific IgE levels were determined for pea and peanut with the CAP system FEIA. IgE-binding proteins in pea and peanut were identified by using immunoblot analysis. Cross-reactivity was studied by means of immunoblot and ELISA inhibition studies with whole extracts and purified allergens. Results: Peanut-related symptoms consisted of oral symptoms in all patients, with additional urticaria and dyspnea or angioedema in 2 patients. All patients had a positive skin prick test response and an increased IgE level to pea and peanut. Immunoblotting revealed strong IgE binding to mainly vicilin in pea extract and exclusively to Ara h 1 in crude peanut extract. Immunoblot and ELISA inhibition studies with crude extracts, as well as purified proteins, showed that IgE binding to peanut could be inhibited by pea but not or only partially the other way around. Conclusion: Clinically relevant cross-reactivity between pea and peanut does occur. Vicilin homologues in pea and peanut (Ara h 1) are the molecular basis for this cross-reactivity. (J Allergy Clin Immunol 2003;111:420-4.)

Section snippets

Patients

Three patients with a history of severe allergic reactions after ingestion of pea who had peanut-related symptoms were investigated in this study. Specific IgE levels to pea and peanut and total IgE levels were determined by using the CAP system FEIA (Pharmacia & Upjohn, Uppsala, Sweden). Skin prick tests with commercial pea and peanut extracts (ALK-Abelló, Nieuwegein, The Netherlands) were performed and recorded as described by Dreborg and Frew.22 Detailed histories of pea- and peanut-related

Patients

Patient characteristics are summarized in Table I. Pea-related symptoms consisted of symptoms of itching and tingling of the oral cavity or lips and dyspnea in all patients. Two patients (nos. 1 and 3) experienced additional symptoms, such as generalized urticaria and cardiovascular symptoms, resulting in faintness. This required attendance at an emergency department more than once. Ingestion of peanut also induced oral symptoms in all patients: in patient 1 this was accompanied by generalized

Discussion

Three patients with histories of severe anaphylaxis after ingestion of pea were investigated regarding their peanut-related symptoms. In one patient peanut-related symptoms were confirmed by means of DBPCFC. The other 2 patients were not challenged with peanut because they had convincing histories of peanut anaphylaxis (Table I). Looking at the specific IgE levels, skin prick test results, and the course of development of food-related symptoms in these patients, it is assumed that their

Acknowledgements

We thank W. J. Koers for his help in recruiting patients with pea allergy and R. Vlooswijk and R. van Biert for their assistance in Western blot and ELISA experiments.

References (31)

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    Crossallergy is based on epitope similarity among proteins from different organisms, i.e., crossallergy between organisms of different species is due to the presence of structurally homologous proteins, which are recognized by the same IgE antibodies. The high sequence homology observed among legume vicilins (peanut, soybean, pea, and lentil) has been claimed as responsible for the IgE crossreactivity detected among these grain legumes [51–53]. For example, the risk of crossed allergy between lupine and peanut was documented as early as 1994 [54].

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Supported by TNO Nutrition and Food Research.

☆☆

Reprint requests: Marjolein Wensing, MD, Department of Dermatology/Allergology G02.124, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.

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