Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children.
BACKGROUND
Reports of allergy to lupine derivatives (as de novo sensitization or cross-reactivity in subjects allergic to peanut) are increasing as their use in food products increases.


OBJECTIVE
The aim of this study was to assess: (1) lupine tolerance in a group of children allergic to peanut, using lupine enriched-pasta instead of raw flour as has been done in previous clinical studies; (2) whether technological treatments of lupine modify its cross-reactivity or co-sensitization with peanut; (3) the role of lupine seed proteins in sensitization, and (4) to identify the eliciting doses (EDs) by using double-blind, placebo-controlled food challenges (DBPCFC).


METHODS
Twelve patients with a history of clinical allergic reactions to peanut were evaluated by skin prick tests (SPTs), the ImmunoCAP test, immunoblotting, and DBPCFC. The 12 selected subjects were included in a trial where lupine-enriched pasta and placebo pasta were administered in a DBPCFC protocol.


RESULTS
Positive clinical reactions were observed in two children, the EDs being 0.2 and 6.4 g of pasta, corresponding to 50 mg and 1.6 g of lupine proteins, respectively. Beta-conglutin was the protein most involved in SPT positivity.


CONCLUSIONS
Lupine-enriched pasta can be tolerated by most subjects suffering from peanut allergy, but a sizeable minority (2/12 of them in this case) can develop potentially dangerous clinical reactions. Information about possible reactions to lupine derivatives by those allergic to peanuts must be included in the labelling of lupine-enriched products to protect consumers at risk.
Fiocchi
A
A
Department of Child and Maternal Medicine, The Melloni University Hospital, Milan, Italy. allerg@tin.it
Sarratud
P
P
Terracciano
L
L
Vacca
E
E
Bernardini
R
R
Fuggetta
D
D
Ballabio
C
C
Duranti
M
M
Magni
C
C
Restani
P
P
D000293:Adolescent; D010367:Arachis / Q000009:adverse effects / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004044:Dietary Proteins; D004306:Dose-Response Relationship, Immunologic; D004311:Double-Blind Method; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D031297:Lupinus / Q000009:adverse effects* / Q000276:immunology*; D008297:Male; D021183:Peanut Hypersensitivity / Q000276:immunology*; D012680:Sensitivity and Specificity; D012882:Skin Tests
D004044:Dietary Proteins; D007073:Immunoglobulin E