Peanut/Soya

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Jan Hed, Clin Immunologist, MD, PhD
Karolinska Institutet, IMPI, Div of Clin Immunology
Huddinge University Hospital, Sweden
 
The statements below are based on conclusions from selected publications. Their intention is to highlight recent research and information that could be beneficial in allergy in vitro testing. They can include seemingly contradictory statements due to differences in selecting patient populations as well as in the study design.
  • Peanut is one of the most allergenic food known. Peanut allergy is seldom outgrown, and allergic reactions are often acute and severe (1).
     
  • A high cross-reactivity exists in legume-allergy between peanut, soy, lentils and beans (2, 3), but is often not confirmed with challenge studies (3, 4).
     
  • There is a close relation between sensitization to soy and peanut (70%) in children with food intolerance, but the clinical sensitivity to soy is rather rare (5).
     
  • In a population of atopic children only 6 % had a positive skin test to soy and 20% of these had a positive challenge test, indicating that soy allergy is not common in atopic children (6). In a similar study, the corresponding values were 21% for a positive skin test and 6% for a positive challenge test (7).
     
  • Early sensitization to peanut can occur through milk formulas that contain peanut oil (8,9). Patients react to crude peanut oil, but not to refined peanut oil (10, 11).
     
  • The incidence of history-based allergy to soy protein formulas (SPF) is 27% but in challenge studies, only 3-4% of the patients taking SPF gave a positive reaction (12).
     
  • The major allergen of peanut is easily released in the mouth and, like other legume allergens, has a high natural resistance to thermal, chemical and proteolytic denaturation (13).
     
  • Peanut allergy is a common phenomenon (23%) in individuals monosensitized to grass (14), but not in individuals monosensitized to birch (tree) (15) or mugwort (weed) (16).
     
  • Cross-reactive IgE directed to carbohydrate determinants of grass pollen and peanut has been found and is believed to have poor biological activity (17).
     
  • The prevalence of peanut sensitization at 4 years of age is around 1% and about half of these have clinical symptoms (18).
     
  • The first clinical reaction to peanut occurs at home before 2 years of age (19,20,21) and seldom after 17 years of age (22). In most patients (>70%) the reaction was believed to result from the first exposure (19, 23).
     
  • Persistent peanut allergy is more common in patients with other food allergies (20).
     
  • Severe symptoms are more common in adults (23) and often coexist with tree-nut allergy (21). One third of peanut allergic patients were also sensitized to tree-nuts in one study (19).
     
  • Peanut IgE > 15 kU/l in a highly atopic population predict (>95%) clinical reaction at exposure and eliminate the need to perform food challenge tests (24).
     
  • Peanut sensitization is common, together with wheat and tree nut sensitizatin, in exercise-induced asthma (25).
     
  • Epidemics of asthma have occurred in relation to inhalation of soy dust from unloading grain silo (26).

References:

    1. Lehrer SB, Taylor SL, Hefle SL, Bush RK. Food Allergens. In: Kay AB, editor. Allergy and Allergic Diseases. Blackwell Science Ltd. 1997:961-80.
    2. Kalogeromitros D, Armenaka M, Galatas I, Capellou O, Katsarou A. Anaphylaxis induced by lentils. Ann Allergy Asthma Immunol 1996;77:480-2.
    3. Eigenmann PA, Burks AW, Bannon GA, Sampson HA. Identification of unique peanut and soy allergens in sera adsorbed with cross-reacting antibodies. J Allergy Clin Immunol 1996;98(5 Pt1):969-78.
    4. Yunginger, JW. Classical food allergens. Allergy Proc 1990;11:7-9.
    5. Bardare M, Magnolfi C, Zani G. Soy sensitivity: personal observation on 71 children with food intolerance. Allerg Immunol (Paris) 1988;20:63-6.
    6. Bruno G, Giampietro PG, Del Guercio MJ, Gallia P, Giovannini L, Lovati C et al. Soy allergy is not common in atopic children: a multicenter study. Pediatr Allergy Immunol 1997;8:190-3.
    7. Magnolfi CF, Zani G, Lacava L, Patria MF, Bardare M. Soy allergy in atopic children. Ann Allergy Asthma Immunol 1996;77:197-201.
    8. de Montis G, Truong M, Toussaint B, Berman D, Toudoire C. (Peanut sensitization and oily solution vitamin preparations). (Article in French). Arch Pediatr 1995;2:25-8.
    9. Dean TP, Clarke MC, Hourihane JO, Dean KR, Warner JO. Application of an electrophoretic methodology for identification of low molecular weight proteins in foods. Pediatr Allergy Immunol 1996;7:171-5.
    10. Hourihane JO, Bedwani SJ, Dean TP, Warner JO. Randomised, double blind, crossover challenge study of allergenicity of peanut oils in subjects allergic to peanuts. BMJ 1997;314:1084-8.
    11. Teuber SS, Brown RL, Haapanen LA. Allergenicity of gourmet nut oils processed by different methods. J Allergy Clin Immunol 1997;99:502-7.
    12. Cantani A, Lucenti P. Natural history of soy allergy and/or intolerance in children, and clinical use of soy-protein formulas. Pediatr Allergy Immunol 1997;8:59-74.
    13. Lalles JP, Peltre G. Biochemical features of grain legume allergens in humans and animals. Nutr Rev 1996;54(4 Pt1):101-7.
    14. de Martino M, Novembre E, Cozza G, de Marco A, Bonazza P, Vierucci A. Sensitivity to tomato and peanut allergens in children monosensitized to grass pollen. Allergy 1988;43:206-13.
    15. Boehncke WH, Loeliger C, Kuehnl, Kalbacher H, Bohm BO, Gall H. Identification of HLA-DR and -DQ alleles conferring susceptibility to pollen allergy and pollen associated food allergy. Clin Exp Allergy 1998;28:434-41.
    16. Garcia Ortiz JC, Cosmes PM, Lopez-Asunsolo A. Allergy to foods in patients monosensitized to Artemisia pollen. Allergy 1996;51:927-31.
    17. van der Veen MJ, van Ree R, Aalberse RC, Akkerdaas J, Koppelman SJ, Jansen HM, van der Zee JS. Poor biological activity of cross-reactive IgE directed to carbohydrate determinants of glycoproteins. J Allergy Clin Immunol 1997;100:327-34.
    18. Tariq SM, Stevens M, Matthews S, Ridout S, Twiselton R, Hide DW. Cohort study of peanut and tree nut sensitisation by age of 4 years. BMJ 1996;313:514-7.
    19. Sicherer SH, Burks AW, Sampson HA. Clinical features of acute allergic reactions to peanut and tree nuts in children. Pediatrics 1998;102:E6.
    20. Hourihane JO, Roberts SA, Warner JO. Resolution of peanut allergy: case-control study. BMJ 1998;316:1271-5.
    21. Ewan PW. Clinical study of peanut and nut allergy in 62 consecutive patients: new features and associations. BMJ 1996;312:1074-8.
    22. Foucard T, Edberg U, Malmheden-Yman I. (Fatal and severe food hypersensitivity. Peanut and soy underestimated allergens). (Article in Swedish). Läkartidningen 1997;94:2635-8.
    23. Hourihane JO, Kilburn SA, Dean P, Warner JO. Clinical characteristics of peanut allergy. Clin Exp Allergy 1997;27:634-9.
    24. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997;100:444-51.
    25. Guinnepain MT, Eloit C, Raffard M, Brunet-Moret MJ, Rassemont R, Laurent J. Exercise-induced anaphylaxis: useful screening of food sensitization. Ann Allergy Asthma Immunol 1996;77:491-6.
    26. Pont F, Gispert X, Canete C, Pinto E, Dot D, Monteis J. (An epidemic of asthma caused by soybean in L´Hospitalet de Llobregat). (Article in Spanish). Arch Bronchoneumol 1997;33:453-6.