Could pea protein burgers cause a reaction if you are allergic to peanuts?

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Q: My family often eats vegan foods, which are a good match for our 12 year old’s dairy allergy. However, when we recently ate new plant-based burgers made from pea protein, our son got hives on his face and a swollen lip. (It got better with Zyrtec.) In addition to dairy, our son has peanut and lentil allergies. Is it possible that he is also now allergic to peas? Should we test?

Dr Sicherer: From your description, I’m assuming your 12 year old tolerated green peas until the reaction to the pea protein burger. More and more products are using concentrated protein from beans (legumes). Some common types: bread and pasta flour made from lentils, lupine or chickpeas; the use of soy concentrate (soy protein concentrate / isolate) in processed foods; and, as you have identified, the use of concentrated pea protein. The growing number of products fortified with pea protein, including processed meats but also yogurts, cookies, health supplements and the like, generally use a type of pea known as yellow, dun, or field peas.

When evaluating an allergy like this, I think about the knowledge we have and the history of the patient. According to studies, about 95 percent of people with allergies to peanuts tolerate other legumes (although most will have positive skin or blood tests for several beans). However, if someone with a peanut allergy has had a reaction to other legumes, like lentils in your son’s case, I may be wary of other beans that I call “potent”. These are: lupine, chickpea, lentil, yellow pea (dun), green pea and soybean. Typically, if there is a bean allergy, it is not seen as often for other types (black, white, kidney, lima, green, etc.).

In addition, it is possible to have an allergy to one or more beans without being allergic to peanuts. For example, allergy to lentils or lupine without allergy to peanuts or other beans. Or allergy to yellow peas without allergy to peanuts.

I have a lot of questions to ask: What other beans is your child eating or not eating? How much does he eat, how often and when was the last time? Has he had any subtle issues with beans in the past? How much was consumed and how severe were the previous reactions to legumes? The answers would give me clues as to how to approach this situation. If a child had reactions to beans, especially more than one type, I would become more suspicious of other types.

A common myth is that allergy is characterized by reactions to a tiny minute amount of a food. However, many people with allergies may not experience any symptoms unless they consume relatively large amounts, perhaps beyond one serving. This is especially evident with allergies to beans. With soy allergy, tofu and edamame can be tolerated as an ingredient, but not soy milk or soy protein concentrate. Either lentils on a salad can be tolerated but not lentil soup, or split beans are tolerated but not bean-based pasta.

So a child who has never had problems with green peas in peas and carrots, peas in rice or as a side dish may show symptoms of pea soup or pea protein in a burger. In the latter, the amount of protein ingested is much higher. In fact, many products that contain yellow pea protein as a key ingredient aim to increase protein content. The products may contain pea protein, pea protein isolates, pea fiber, hydrolyzed pea protein, etc. These are all examples where more concentrated amounts of protein can cause the problem.

Your allergist may indeed want to confirm the reaction of the burger with a yellow pea skin test. Assuming peas are the culprit, the question may arise as to whether peas should be avoided entirely or allowed in previously tolerated forms and amounts, and whether other beans are of concern. This discussion usually takes into account the patient’s history, the severity of the reaction, the motivation to keep the food in the diet in tolerated forms, and the risks of complete elimination (social, nutritional and possibly allergic). In some cases, oral provocations under medical supervision may be necessary.

Dr Scott Sicherer is a practicing allergist, clinical researcher and professor of pediatrics. He is Director of the Jaffe Food Allergy Institute and Head of the Department of Pediatric Allergy and Immunology at the Icahn School of Medicine at Mount Sinai in New York. He is also the author of Food Allergies: A Complete Guide to Eating When Your Life Depends On It.

Related reading:
Will a child with peanut allergy react to peas and beans?
Will a child with peanut allergy react to chickpeas as well?
Manage life by avoiding soy or other legumes

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