Lupin and peanut cross reactivity
We are starting to field more questions from peanut-allergic patients regarding possible cross-reactivity with lupin. None of these patients have had a reaction to lupin, however are wondering if they should avoid it based on known peanut allergy. We do not generally tell all peanut allergic to avoid all legumes as tolerance is generally high for most patients. What is the best advice for these patients?
We spoke to Dr. Sicherer on the topic and he had the below thoughts:
Allergy to lupin (lupine) might occur from primary allergy to this bean (which is often used as a flour) or because of cross-reactivity to legumes. There are no large comprehensive studies to ascertain the rate of lupin allergy among those with peanut allergy. Based on various small studies in adults and children, which may have various biases in patient selection for testing and oral challenge, and were not performed in the US (where lupin products are not so common), results suggest that sensitization rates are in the 15-35% range (highest reporting 82%) and reaction rates are probably a minimum of 4% (a pediatric study) and may be upwards of 20% (highest reporting 35%).1-6
It seems warranted to caution peanut –allergic patients about lupin, but I am especially concerned if the peanut allergy is severe/low threshold or if there is already a history of multiple legume allergy.
1. Peeters KA, Nordlee JA, Penninks AH, Chen L, Goodman RE, Bruijnzeel-Koomen CA, et al. Lupine allergy: not simply cross-reactivity with peanut or soy. J.Allergy Clin.Immunol. 2007; 120:647-53.
2. Peeters KA, Koppelman SJ, Penninks AH, Lebens A, Bruijnzeel-Koomen CA, Hefle SL, et al. Clinical relevance of sensitization to lupine in peanut-sensitized adults. Allergy 2009; 64:549-55.
3. Shaw J, Roberts G, Grimshaw K, White S, Hourihane J. Lupin allergy in peanut-allergic children and teenagers. Allergy 2008; 63:370-3.
4. Fiocchi A, Sarratud P, Terracciano L, Vacca E, Bernardini R, Fuggetta D, et al. Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children. Clin Exp.Allergy 2009; 39:1045-51.
5. Mennini M, Dahdah L, Mazzina O, Fiocchi A. Lupin and Other Potentially Cross-Reactive Allergens in Peanut Allergy. Curr Allergy Asthma Rep 2016; 16:84.
6. Ballabio C, Penas E, Uberti F, Fiocchi A, Duranti M, Magni C, et al. Characterization of the sensitization profile to lupin in peanut-allergic children and assessment of cross-reactivity risk. Pediatr Allergy Immunol 2013; 24:270-5.
Scott H. Sicherer, MD
We also have a new patient article on the website that might be of interest to your patients. You can find it here.
Patricia McNally, MD, FAAAAI