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Month: June 2021

Lupin Allergy

Lupin is a legume and belongs to the same plant family as peanuts. In some countries, it is widely grown as a flowering plant for animal feed. In other countries, lupin beans, which are actually the seeds of lupin, are used in the human diet. Lupin beans are high in antioxidants, dietary fiber, and protein and low in starch. Lupin beans can be processed into flour or bran and is used to add fiber, texture, and protein in food manufacturing. The beans may be eaten whole, boiled, or dry and are a common snack in Europe and Asia. Lupin is a particularly common food in the Mediterranean region and in Asian countries. In this global world, lupin is now becoming more common in North America, although most Americans have not heard of lupin.

Lupin is used as an ingredient in a variety of products. These products are very diverse and may include baked goods (e.g., bread, biscuits, rolls, cakes, cookies), pasta, sauces, salads, lupin hummus spreads, chocolate spreads, stews, and ice creams. Some fish and meat dishes (e.g., sausage, hamburger) may also contain lupin. Drinks may also contain lupin as a milk or soy substitute. Lupin is gluten-free and may be found in gluten-free products as a substitute for wheat, rye, or barley. Lupin-derived ingredients are good alternatives for gluten-containing flours and are regularly being used in gluten-free products. It should be noted that there are various other names for lupin some of which may include lupin seed, lupine, lupini, lupinus, altramuz, hasenklee, tarwi, termes, termos, and turmus.

Lupin allergy is much more common in individuals with a history of a peanut allergy, though it can occur in individuals who can tolerate peanut products. Cross-reactivity between peanut and lupin, as investigated by rates of skin prick testing, has been reported to be as high as 44%. Still, for most individuals, lupin beans and lupin flour is safe to eat, although there is an increasing number of case reports of allergic reactions after exposure to lupin-containing products. The severity of allergic reactions to lupin vary from very mild localized reactions in the mouth to severe life-threatening anaphylaxis.


The symptoms of an allergic reaction to lupin is similar to that of other food allergies. They can manifest as itchy mouth, itchy tongue, itchy throat, itchy eyes, watery eyes, sneezing, nausea, vomiting, diarrhea, abdominal pain, itchy skin, hives and/or other rashes. More severe life-threatening anaphylactic reactions are less common but may present as wheezing, coughing, chest tightness, shortness of breath, dizziness, drop in blood pressure, increased heart rate, and/or loss of consciousness. Uncontrolled asthma is a risk factor for a more severe reaction. Skin exposure to lupin flowers may also cause a contact dermatitis reaction in some sensitized individuals.


When the history is suggestive of lupin ingestion and the onset of symptoms occur after exposure to lupin-containing products, the diagnosis can be confirmed by skin allergy prick tests, either to a commercially available testing reagent or with the suspect food itself. Specific antibodies to lupin can also be detected in some laboratory tests. In some cases, an oral food challenge, which is a supervised feeding of gradually increasing amounts of a lupin-containing food, may be conducted in the allergist’s office to determine whether a patient is able to eat and tolerate lupin.


As is the case with other food allergies, avoiding exposure to lupin is the only known way to prevent adverse reactions. It is important to carefully read the labels of packaged foods and also to be aware of possible symptoms of allergic reactions. As of 2006, the European Commission has required that food labels indicate the presence of lupin in food. It should be noted however that in many countries (e.g., U.S., Canada, Australia) emphasis for allergen labeling for lupin is not mandatory as it is for some of the more common food allergens (e.g., peanuts, tree nuts, soy, milk, eggs). It is also important to emphasize that individuals with a history of a severe systemic reaction to lupin should carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) and should receive training in its proper usage. If the self-injectable epinephrine device is used, the individual should go immediately to the closest emergency room.

If you think that you may have lupin or any other food allergy, the board certified allergists at Black & Kletz Allergy would be happy to help you.  We have 3 convenient offices in the DC metro area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking.  Our Washington, DC and McLean, VA locations are Metro accessible. There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  Please call us for an appointment. Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergists at Black & Kletz Allergy have been treating both adults and children in the Washington, DC metropolitan area for allergies, asthma, sinus disease, and immunologic disorders for more than half a decade.  We strive to provide top-of-the-line allergy relief in a compassionate and professional environment.

Swelling Episodes (Angioedema)

Swelling episodes may occur randomly in individuals.  The medical term for such swelling occurrences is “angioedema.”  These episodic swellings may occur alone or they may occur in conjunction with hives (i.e., urticaria) and/or generalized itching (i.e., pruritus).  The severity, duration, and location of the swelling episode(s) may vary greatly from one individual to another.  It should also be noted that hives or generalized itching may occur separately without the presence of angioedema.

The most common location for angioedema to occur tends to be on the face, particularly of the eyelids or lips.  The hands and feet are less commonly affected, but are not uncommon.  Swelling of the gastrointestinal and respiratory tracts also occur, but in general, are a rare occurrence.  It is important to realize that swelling of the throat can be life-threatening and those individuals who experience throat tightening should be prescribed a self-injectable epinephrine device such as an EpiPen, Auvi-Q, or Adrenaclick.  Patients should be told that if they use their device, they should immediately go to the closest emergency room.

Angioedema occurs because there is a leakage of fluid through small blood vessel walls which in turn causes soft tissue swelling.

The causes of angioedema can be classified into 4 basic groups:  allergic, non-allergic drug reaction, hereditary, and idiopathic.

Allergic causes of angioedema may include drug allergies [e.g., penicillin, sulfa, vaccines, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs)], food allergies (e.g., peanuts, tree nuts, shellfish, fish, milk, eggs), insect venom allergies (e.g., honey bees, wasps, yellow jackets, hornets, fire ants), and latex allergy (e.g., gloves, condoms, catheters, balloons, dental dams).

The non-allergic drug reactions may include medications from the following classes of medications:  ACE inhibitors (e.g., Enalapril, Lisinopril, Ramipril), angiotensin II receptor antagonists (e.g., losartan, candesartan, olmesartan, valsartan), proton pump inhibitors (e.g., sertraline, citalopram, fluoxetine, escitalopram, paroxetine), selective serotonin reuptake inhibitors (SSRIs) (e.g., omeprazole, pantoprazole, lansoprazole, esomeprazole), and statins (e.g., atorvastatin, pravastatin, simvastatin, rosuvastatin).

Hereditary angioedema is caused by an inherited abnormal gene that causes a deficiency of a normal protein called C1 esterase inhibitor.  This deficiency leads to recurrent swelling episodes which usually begin after puberty.  These swelling episodes are not associated with hives and can either be spontaneous or triggered by infection, alcohol, hormonal changes, physical stress, or mental stress.

Idiopathic angioedema is just a fancy way of saying that we do not know the underlying cause of the swellings.  Autoimmune disorders (e.g., rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome) may play a role however.

The diagnosis of angioedema may require blood work and/or skin testing depending on the history and physical that is obtained from the patient.  The history is very important and may provide clues to the origin and source of the angioedema.  If the angioedema is recurrent and has re-occurred for more than 6 weeks, blood work is usually ordered in order to rule out an underlying condition that may be the cause of the swelling episodes.  Allergy skin tests may be done in order to rule out food, insect venom, latex, or medication allergies.

The treatment of angioedema depends on the severity and chronicity of the swelling episodes.  In mild acute angioedema, epinephrine injection into the muscle can be performed along with intramuscular injection of an antihistamine and/or a corticosteroid.  An alternative would be oral administration of an antihistamine and/or corticosteroid.  Severe acute angioedema is treated similarly, however, keeping the airway open is the main goal.  For that reason, the use of intramuscular epinephrine is often utilized, particularly if the swelling occurs in the throat or respiratory tract.  The treatment of chronic recurrent angioedema may involve the use of oral antihistamines, H2-blockers, leukotriene antagonists, and/or corticosteroids.  The treatment of hereditary angioedema involves the use of intravenous C1 inhibitor concentrate.  It can also be infused prophylactically about 1 hour before a surgical procedure in order to prevent swellings.  Newer medicines such as Firazyr (icatibant) and Kalbitor (ecallantide) may also be used to treat this genetic condition.

The board certified allergy doctors at Black & Kletz Allergy have been diagnosing and treating angioedema for more than 50 years.  We treat both pediatric and adult patients.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our office locations have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  In addition, our McLean office offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from swelling episodes, hives, generalized itching, and/or any other allergy, we are here to help alleviate or hopefully end your undesirable symptoms.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, caring, and professional environment.