title: Anaphylactic reaction to lupine flour.
abstract: Roasted lupine seeds have been used as snack food in Mediterranean countries for years. Since the 1990s, lupine flour has been used as a substitute for or additive to other flours in countries of the European Union; usually the amount is so low that no declaration is required. Since 1994, a number of cases of immediate-type allergy to lupine flour-containing products have been published. A 52-year-old woman developed facial and mucosal edema, followed by dizziness and shortness of breath a few minutes after ingestion of a nut croissant containing lupine flour; she required emergency care. Allergy diagnostic tests revealed a total IgE of 116 kU/l, a highly elevated concentration of IgE specific for lupine seed (42.9 kU/l) and birch pollen IgE of 2.57 kU/l. Skin prick test with native lupine flour was strongly positive. Allergy against lupine seeds may develop de novo or via cross-reactivity to legumes, particularly peanuts, the latter being detectable in up to 88% of cases, founded on a strong sequence similarity between lupine and peanut allergens. In our patient, no cross-reactivity could be detected via immunoblotting, indicating a rare monovalent sensitization to lupine flour. Treatment consists of avoidance of lupine flour-containing products. Patients with proven peanut allergy should also avoid lupine flour because of the major risk of cross-reaction.
authors.affiliation: University Dermatology Clinic, Heidelberg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Brennecke
authors.forename: Wolf-Meinhard
authors.initials: WM
authors.lastname: Becker
authors.forename: Ute
authors.initials: U
authors.lastname: Lepp
authors.forename: Uta
authors.initials: U
authors.lastname: Jappe
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis*; D003876:Dermatitis, Atopic / Q000139:chemically induced* / Q000175:diagnosis*; D005260:Female; D005433:Flour / Q000009:adverse effects*; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D031297:Lupinus / Q000009:adverse effects*; D008875:Middle Aged