The case of Fenugreek
Up until a week ago, I had never heard of fenugreek. On my first day back at Riley to start the 2009 new year, I had a young man, just under 2 years of age who presented with concerns about reactions to legumes. The list of suspects included peas, green beans, black beans, baked beans, and lentils. The mother also shared with me that during breast feeding she used ‘fenugreek’. This product is used to help nursing mothers. In our discussion, the mother brought up the concern that the fenugreek may have contributed to the legume reactions.
I had not heard of ‘fenugreek’ prior to this. I have been involved with allergy long enough to know that any food product ingested by mankind for as long as we have been on the planet has been implicated in an allergic response. I wanted to know more about this ‘fenugreek’.
I consulted my online food ‘Allergy Advisor’ regarding fenugreek and got a wealth of information to get me started. To my surprise later that week the Journal of Allergy and Clinical Immunology (JACI) had an article from a group in Norway regarding fenugreek.
Fenugreek (aka Greek hay, Greek fennel, Bird’s foot, Greek hay-seed) is a legume. It is used as a flavoring in many foods including curry, blends of spice, and even tea. As an herbal medication it has been touted as being helpful in initiating and maintaining milk production. There are references for its use in diabetes and hypertension. Importantly, it is a legume and many legumes share certain proteins and may be cross-reactive in some patients.
The purpose of the JACI article was to evaluate the allergenicity and antigenicity of the proteins in fenugreek. There were 29 patients in the study who had specific IgE antibodies to legumes, peanut, soy, pea, lupin, and fenugreek. These patients ranged from 1 to 53 years of age. High levels of antibody to both peanut and fenugreek were found in most patients and the sensitization to fenugreek was believed to be due to cross-reactivity in those patients with peanut allergy. In this study, the reactivity to the other legumes was weaker. Here the other legumes (specifically peanut) were implicated in causing sensitization to fenugreek. With the young lad that I saw I wondered if there is the possibility that the fenugreek may have worked in the opposite direction – fenugreek exposure causing sensitization to the other legumes.
I was not aware of this association: fenugreek and peanut. In my clinic notes I debated about doing the peanut test since he had no exposure, but since he reacted to a large number of the other legumes I had the skin test placed. His response was positive to peanut.
The world of IgE-mediated reactions to foods is growing significantly. Our diets are changing with significantly more opportunities for ingredients in foods from other lands becoming part of our lives. Herbal supplements may contain a variety of items that could lead to sensitization. It is important to inquire about the use of such products.
Leickly Stories 
If my daughter is allergic to peanuts should she stay away from garbanzo beans and other legumes? He allergy is diagnosed through a prick test.
Great question- only that is frequently asked and I am sure you have heard many different thoughts on this. The recommendation depends on the situation. Why were the other legumes tests performed? If the history was only for peanut- that is what I would have only tested for, noting that the value of the allergy test is as good as the story that supports it. If other legumes, peas, beans, soy etc had been eaten without any reactions then I would not have tested for these items. The best test in allergy is the challenge- if the other legumes had been ingested without a problem the test perhaps should not have been done and the result may not be clinically relevent. Now if there is a story that is suspicious for reactions to the other legumes then the tes has relevance.
Back in the 1980’s allergists recommended food family avoidance. In the 1990’s and beyond, that recommendation has fallen by the wayside. Foods of the same families share many common proteins and we see in some children positive results. As the science of food allergy has grown and the experience with food challenges has expanded, many of the previously taught ideas and recommendations have changed.
So back to the beginning- what was the story? Why were the other legumes tested? What have you seen when these were eaten? Did you suspect a problem?
I have seen a few children who have had clinical reactions to a variety of legumes and positive tests to verify that they were allergy mediated.
Without being too long, I hope this helps,
Thank you. She is 7 months old and reacted to milk based formula with hives and lethargy. She was skin tested for other allergens due to this first reaction. She has only eaten a few vegetables, but not peas, beans etc…She was tested for formula, dairy, soy, wheat, egg, peanuts and a few of her veggies as additional controls. The only positives on this test were the formula, dairy and peanuts. Thank you for this information. Enjoy your day.
Wow! I have a severe dairy allergic child who first showed signs of her allergy after early formula supplementation. With my second I was eager to avoid all formula supplementation and would have considered fenugreek if my supply was low. I’m glad it’s something I never had to pursue.
Sensitization does not occur in every child, only those who had the genetic predisposition to go on to develop allergy. With a family history (daughter #1) that puts the next child at an increased risk for allergy. I think agents like this have been around for some time. As we try to find out why there are so many kids with food allergy especially peanut allergy (legume) we should be asking about supplements like this. Thanks for commenting.
Warmest Regards,
Fred Leickly
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I took fenugreek to increase my breastmilk supply because I wasn’t able to keep up with my twins. I also supplemented with formula. My one son reacted to sips of peanut butter milkshake at 8 months with vomiting and hives around his mouth. He had same reaction with eggs. So avoided until he was year and we tried eggs. Within an hour severe vomiting. At that time sent to pediatric allergist and skin tested with significant reactions to eggs, peanuts and tree nuts. My other son didn’t react to any food or the skin test. Though we don’t allow those foods for him either since they share foods. They both have mild eczema. No family history of food allergies or eczema. Did I cause this because of taking fenugreek???