First ever case of anaphylaxis to lupine reported in Canada

Dr Lianne Soller at Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada and colleagues have reported first ever case of anaphylaxis to lupine in Canada in a patient having Peanut Allergy. The case has appeared in Journal Allergy, Asthma & Clinical Immunology.

Lupine is a member of the legume family and is often used in many food products in Europe (e.g. pasta, pizza, sauces, etc.) as a wheat or soy substitute. Lupine cross-reacts with peanut, and cases of allergic reactions to lupine in peanut-allergic patients have been reported in Europe mainly. In contrast, lupine as an ingredient in food products is relatively new to the Canadian market.

The authors describe a 10-year old boy with diagnosed peanut and tree-nut allergy, who developed anaphylaxis to lupine flour in May 2017. Only a few minutes after eating a pre-made pancake mix that didn’t contain any of his known allergens (peanuts, tree nuts), he developed oral pruritis followed by throat tightness, severe stomach ache, lightheadedness, cough, hoarse throat, nasal congestion, sneezing, and fatigue. The patient refused epinephrine but was given cetirizine. The symptoms resolved after 3 h, but he was still unwell the following day. In a conversation between the mother and the allergist, it was determined that lupine was likely the cause of the reaction. To confirm, he was brought into the clinic for skin testing to lupine. Results were consistent with lupine allergy (pancake mix: 10 × 7 mm, lupine bean: 12 × 6 mm). The family has since reported this to the Canadian Food Inspection Agency, resulting in a product recall and a consumer advisory bulletin published by Health Canada.

This is the first reported case of allergic reaction to lupine in Canada and highlights the need for education of Canadian families with the peanut allergy as well as allergists, regarding the possibility of cross-reactivity between peanut and lupine and its new presence in the Canadian food supply. In addition, a precautionary label for those with peanut allergy who purchase products containing lupine should be considered. This case illustrates also the need for a clear mechanism for consumers and allergists to report emerging food allergens to regulatory bodies such as Health Canada.