title: Patients with anaphylaxis to pea can have peanut allergy caused by cross-reactive IgE to vicilin (Ara h 1).
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology/Allergology G02.124, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Wensing
authors.forename: André C
authors.initials: AC
authors.lastname: Knulst
authors.forename: Sander
authors.initials: S
authors.lastname: Piersma
authors.forename: Francesca
authors.initials: F
authors.lastname: O'Kane
authors.forename: Edward F
authors.initials: EF
authors.lastname: Knol
authors.forename: Stef J
authors.initials: SJ
authors.lastname: Koppelman
mesh_terms: D000485:Allergens / Q000302:isolation & purification; D000707:Anaphylaxis / Q000276:immunology*; D010367:Arachis / Q000276:immunology*; D003429:Cross Reactions; D005512:Food Hypersensitivity / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000378:metabolism; D066298:In Vitro Techniques; D021183:Peanut Hypersensitivity / Q000276:immunology*; D018532:Pisum sativum / Q000276:immunology*; D010940:Plant Proteins / Q000276:immunology*; D055314:Seed Storage Proteins
chemical_list: D000485:Allergens; D010940:Plant Proteins; D055314:Seed Storage Proteins; D007073:Immunoglobulin E; C015575:vicilin protein, plant