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Broad Bean–Induced Anaphylaxis: A Case Report

Rodríguez-Mazariego ME1, Fuentes Aparicio V1, Bartolomé Zavala B2, Acevedo Matos M1, Zapatero Remón L1

1Servicio de Alergia, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain

2Departamento I+D, Bial-Arístegui, Bilbao, Spain

J Investig Allergol Clin Immunol 2016; Vol. 26(6): 374-375 doi: 10.18176/jiaci.0096

Key words: Broad bean. Food allergy. Anaphylaxis. Food processing. Palabras clave: Habas. Alergia alimentaria. Ana laxia. Procesamiento

de alimentos.

Broad bean (Vicia faba) is a herbaceous climbing plant that can self-pollinate and grow in any type of soil. It is now cultivated throughout the world and commonly used in cooking. Vicia faba belongs to the Fabaceae family and comprises 3 distinct varieties: Vicia faba var minor, Vicia faba var equina, and Vicia faba var major, which is the most widely eaten. Broad beans are eaten raw, cooked, or fried and have recently been used as our in various kinds of bread [1]. Allergic reactions to broad beans have rarely been reported in the literature [1,2]. Cross-reactivity has been reported between pollen of the mesquite tree (Prosopis juli ora) and some legumes, such as broad beans [3].

Food processing can denature proteins or create new epitopes, thus modifying allergenicity [4]. For example, roasting can increase the allergenicity of peanut proteins [5] and reduce the allergenicity of hazelnut and almond proteins [6]. Combining heat and digestion by pepsin in broad beans can slightly reduce immunoreactivity [7], as reported with tomato [8]. Most in vitro studies on the allergenicity of nonspeci c lipid transfer proteins and seed storage proteins show that the proteins are thermostable when subjected to thermal processing methods [9]. However, the role of lipids as the allergens responsible for the reactions is increasingly well-known [10].

We report the case of a 5-year-old boy with no previous history of allergy who developed cough, dyspnea, auricular erythema, papules on the trunk, abdominal pain, nausea, and vomiting 2 hours after dinner. The symptoms disappeared several hours after treatment with adrenaline, antihistamines, and corticosteroids in the emergency department. Immediately before dinner, he had eaten a legume-based snack containing pistachio, peanuts, sun ower seeds, hazelnuts, almond, pine nuts, and fried broad beans. Between the episode and the rst visit to the allergy clinic the child avoided tree nuts. He did not experience further episodes.

Skin prick testing was negative with extracts from pistachio and walnut (Bial-Arístegui), peanut, and almond (Leti) and positive with hazelnut (7×3 mm), sun ower seeds (6×3 mm, Bial-Arístegui), and pine nut (8×4 mm, Leti). Skin prick testing was also positive with Pru p 3 (10×5 mm) and negative with pro lin from Phoenix species pollen. Prick-by-prick testing was negative with roasted peanut, almond, and sun ower seeds and positive with cooked, raw, and fried broad beans (6×4 mm, 7×3 mm, and 6×3 mm, respectively). Skin prick tests were negative with commercial extracts from dander (dog and cat), molds, mites, and pollen (grass, olive, and pellitory) and was positive with pollens from Platanus species (3×4 mm), mugwort (3×4 mm), Plantago species (3×4 mm), Chenopodium species (4×4 mm), and ash (3×3 mm). The histamine wheal diameter was 7×5 mm.

Blood tests using the ImmunoCAP assay (Phadia) revealed total IgE of 119.0 kU/L and speci c IgE determinations (kUA/L) of 4.97 to peanut, 2.85 to hazelnut, 16.1 to walnut, 8.55 to sun ower seeds, and 0.64 to almond. Serum speci c IgE was positive to Ara h 9 (23.2 kUA/L), Cor a 8 (6.72 kUA/L), and Pru p 3 (27.4 kUA/L) and negative for Ara h 2 (0.01 kUA/L).

Speci c IgE to fried broad beans determined using the enzyme allergosorbent test (HYTEC Speci c IgE EIA kit, HYCOR Biomedical Ltd) was 0.8 kUA/L (class 2).

ABC PCPCPCM

Figure. SDS-PAGE immunoblotting results. A, Extract from raw broad bean. B, Extract from cooked broad bean. C, Extract from fried broad bean. Lane P, patient's serum; Lane C, control serum (pool of sera from nonatopic individuals); Lane M, molecular mass marker.

kDa

97.0 66.0

45.0

30.0

20.1

14.4

© 2016 Esmon Publicidad

J Investig Allergol Clin Immunol 2016; Vol. 26(6): 374-402

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