food allergies

Fenugreek and Legume Sensitivity

fleickly7 Comments

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.

My letter to the editor of Bottom Line Personal

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I have never written a letter to the editor that I have actually sent. Most of them wind up in the circular file (aka file 13, trash etc). I usually feel better having written them, but I do not have a track record in this regard. Perhaps doing this blog has emboldened me. After all it is an opinion, but sometimes we see things that we truly feel are wrong and we need to warn others about these wrongs.

The story goes as follows. I have subscribed to a newsletter called ‘Bottom Line Personal’. This publication has short articles on a variety of topics. For example, the last issue has quips on investing, real estate, psychotherapy, painkillers, career starting, bed sharing, and dangers in your garage (as I listed these it made me wonder why I subscribe). There is a page that talks about the purpose of the publication which is to bring to the reader the best information from the most knowledgeable sources in the world in helping the reader gain “greater wealth, better health, more wisdom, extra time and increased happiness” (this is a direct quote). Way at the bottom of the disclosure panel is the statement that they publish the opinions of expert authorities in the fields. I came across an article in the news column that started “If you think you are allergic to a certain food…..” That certainly caught my eye. As I read on my interest turned to rage (not really rage but my feathers were rattled). The first line continued “….. but you aren’t sure which food-consider having a blood test for the immunoglobulin IgG, says the author of a book called ‘The Source: Unleash Your Natural Energy, Power Up Your Health and Feel Ten Years Younger'”.

So I am concerned that my newsletter (one I subscribe to) which focuses on saving money and promoting health would promote this book specifically this concept of IgG to food as being something of value and something well established in health care. So I carefully composed a letter citing references from the Food Allergy and Anaphylaxis Network (FAAN) and from the American Academy of Allergy, Asthma, and Clinical Immunology. I also did a literature search on the author of the book using PubMed and OVID. My letter explained that the measurement of IgG to food is unproven as a diagnostic test and should be considered experimental. It is known that IgG to foods does not sort out a healthy from a sick population. The thought is that we see IgG to food in healthy people. To date, this is a test looking for a disease.

Thinking that I may have missed something, my search for published articles by the author on this topic in peer-reviewed journals came up with nothing.

I went on to point out that IgG to food is on a rather long list of unproven diagnostic tests for allergy. I pointed out that prior to publishing their review on the topic that they should have done more research on the topic, utilizing position statements from the major organization involved with allergy and perhaps used a literature review of evidence-based medicine to see the value of a test for IgG directed to foods.  My bottom line was that this was not money well spent and could possibly lead to more harm for someone. I even went so far as to make some analogy to the use and sale of snake oil.

I carefully looked over my 750 word editorial, criticized the editors for violating their own standards and sent it off. Needless to say, I thought I was doing a service in pointing out my concerns.

Respectfully submitted,

Fred Leickly

Story continued- I got a response from ‘Bottom Line’- “Thank you for your email.  We welcome your feedback.  We find that on occasion even well-respected experts disagree and this appears to be one of those times. Again, I thank you for taking to the time to explore this topic with us.”

Ugh! I still feel better for the effort!