Lupine inhalation induced asthma in a child

Abstract

The ingestion of lupine seed flour has been reported as a cause of allergic reactions. There is some evidence of its allergenic potential after inhalation. An 8-year-old asthmatic child, who was allergic to peanut, was studied in our clinic with the suspicion of an adverse drug reaction due to salbutamol. He suffered an asthma attack while playing with his brother, who had been eating lupine seed as snack; surprisingly, the asthma attack worsened with salbutamol. The skin tests showed a positive result with Lupinus albus extract, peanut, garbanzo bean, navy bean, pea, green bean, lentil, soy, Olea europea pollen, grass pollen and Plantago lanceolata pollen. The prick-by-prick tests both from dried seeds and those preserved in salt and water were strongly positive. Serum specific IgE antibodies were positive to Lupine albus (1.43 kU/l), peanut (4.32 kU/l), soy (2.15 kU/l), lentil (3.12 kU/l) and garbanzo (0.7 kU/l). After informed consent salbutamol was well tolerated but the patient had asthma in 5 min of manipulation of the lupine seeds. In our case, reactivity with other legumes was also demonstrated, but only peanut allergy was relevant because boiled legumes were tolerated. It is also notorious that anamnesis is so important to assess the true etiological agents of asthma.

Immunoreactivity changes during lupin seed storage proteins digestion

“…Since that time, there have also been reports of allergic reaction during inhalation and prolonged exposure to this plant [4]. Hypersensitivity to the lupin proteins may take different forms such as: urticaria, rhinitis, redness of mucous membranes, swelling of a face, cough and difficulty in breathing [4][5][6]. In extreme cases, response was observed as systemic anaphylaxis [7].…”

Lupin Allergen Detection

“…Additionally, sensitization and triggering of lupin allergy via inhalation (Novembre et al, 1999;Moreno-Ancillo et al, 2005;Reis et al, 2007) and by occupational exposures (Gutierrez et al, 1997;Campbell et al, 2007;Crespo et al, 2001;Parisot et al, 2001) have been described. However, lupin allergy seems to be more often the consequence of cross-reactivity in patients with existing peanut allergy (Hefle et al, 1994;Moneret-Vautrin et al, 1999;Kanny et al, 2000;Leduc et al, 2002;Faeste et al, 2004;Radcliffe et al, 2005;Guarneri et al, 2005;Wassenberg and Hofer, 2007;Lindvik et al, 2008, Shaw et al, 2008.…”

“…The allergic responses range from mild local reactions to systemic anaphylaxis. Reported symptoms include facial edema, mucosal erythema (Brennecke et al, 2007), angioedema (Hefle et al, 1994;Parisot et al, 2001), rhinoconjunctivitis, urticaria, atopic dermatitis, and abdominal symptoms (Gutierrez et al, 1997;Moneret-Vautrin et al, 1999), throat tingling, cough and asthma (Kanny et al, 2000;Moreno-Ancillo et al, 2005;Cambell et al, 2007), oral allergy syndrome (Romano et al, 1997;Quaresma et al, 2007), and anaphylaxis (Matheu et al, 1999;Smith et al, 2004;Radcliffe et al, 2005;De las Marinas et al, 2007;Rotiroti et al, 2007;Wassenberg and Hofer 2007).…”

Opinion of the Scientific Panel on Dietetic products, nutrition and allergies [NDA] related to the evaluation of lupin for labelling purposes

“…c) Sensitisation and triggering via inhalation (Novembre et al, 1999;Moreno-Ancillo et al, 2005) and occupational exposures among individuals with no known allergy to peanuts (Crespo et al, 2001;Parisot et al, 2001). …”