D2.265 - Allergy to peas and lentils: data from the Allergy-Vigilance Network

With the rise of vegetarian diets, legumes are increasingly consumed for their high protein content. Peas and lentils are often the first legumes introduced to children during weaning and are not part of the list of the 14 mandatory food allergens in Europe. However, allergy to legumes is frequent in case of an allergy to peanut and/or another legume and can cause food-induced anaphylaxis. Improving knowledge about food anaphylaxis caused by peas and lentils could help identify clinical profiles at risk of anaphylaxis and discuss the need to add theses legumes to the list of mandatory food allergens.

We retrospectively analyzed food anaphylaxis cases due to peas and lentils recorded by the Allergy-Vigilance Network from 2002 to 2024. Clinical characteristics, severity of reactions (Ring classification modified by Behrendt), location and type of food were described. Univariate analyses were performed to compare the main characteristics of cases according to age groups (children vs adults), and food elicitors (peas vs lentils).

Among the 3285 food anaphylaxis cases, 65 (2.0%) were due to peas (n=33) or lentils (n=32), with 31 cases (47.7%) declared in 2020 or after. Out of these 65 cases, 57 (87.7%) were children and 46 (70.7%) were preschoolers; 41 (65.1%) were boys; 37 (56.9%) had at least another food allergy, of whom 27 were allergic to peanut or another legume. Cofactors were found in 7 cases (10.8%). Grade 2-reactions were predominant (n=48, 73.8%) but there were 13 grade 3 and 1 grade 4 reactions. The latter was due to pea consumption in a 7-month-old baby with respiratory arrest and convulsion. The reaction was inaugural in 39 cases (60.0%). Pea proteins were always consumed in a hidden form whereas split peas, peas, chickpeas and lentils were consumed in its native form or in a soup. Consumption was mostly at home (n=41, 63.0%) followed by restaurant or canteen (n=12, 18.5%). The only significant difference between children and adults cases was a higher rate of cofactors in adults (3/8 vs 4/57, p=0.035). There was no significant difference between cases induced by peas and those induced by lentils.

Anaphylaxis induced by peas and lentils are mostly reported in preschool children and more than a fourth are severe. The number of declared cases seems to increase over time with almost half of the cases declared in 2020 or after. Given these data and the increasing use of these legumes in industrial food, peas and lentils need to be added to the list of mandatory food allergens.