# Fenugreek: New Therapeutic Resource or Emerging Allergen?
## 4 Discussion
### Allergic Reactions to Fenugreek
\begin{tabular}{c c c c c c c} \hline \hline \multicolumn{1}{c}{} & \multicolumn{5}{c}{**Cases of Fenugreek Hypersensitivity**} \\ \hline
**Author** & **Article Type** & **Year** & **Age Sex** & **Symptoms Associated with Fenugreek** & **Previous Adverse Reactions** & **Other Cosensitizations** \\ \hline \multirow{4}{*}{Patiil SP [35]} & \multirow{4}{*}{Clinical trial} & \multirow{4}{*}{1997} & \multirow{4}{*}{36} & F & Sneezing, rhinorrhea, tearing, coughing, and wheezing after smelling. & Chickpeas ingestion. & \multirow{4}{*}{/} \\  & & & & & Nasal obstruction, hoarseness, angioedema, and wheezing after cutaneous contact. & Fenugreek ingestion. & \multirow{4}{*}{/} \\ \cline{2-3} \cline{5-5}  
Based on data recorded on the Norwegian Food Allergy Register from 2000 to 2010, cases of allergy were reported after the ingestion of Indian foods and spices; this could represent a new hidden allergen introduced in recent years through fusion cuisines [42]. The adverse reactions reported to fenugreek appear predominantly as IgE-mediated reactions, ranging from milder forms to actual cases of anaphylaxis. In 2007, a case of biphasic anaphylaxis after curry ingestion was reported. The second curry exposure resulted in frank anaphylaxis a few minutes after consumption. The patient had known allergies to peanuts, in particular to Ara h2 (2s albumin belonging to the seed storage protein family), peas, chickpeas, and lentils [19].  
In our case series, six patients (case nos. 1, 2, 3, 7, 9, and 11) came to our observation for suspected adverse reactions after the ingestion of spices. Skin tests confirmed the clinical suspicion of SPT positivity with fenugreek.  
Furthermore, allergic reactions to fenugreek would be triggered not only by the ingestion of the spice but also by inhalation and/or contact with the spice. However, in our experience, all allergic reactions to fenugreek that came to our observation occurred after ingesting the spice. The first two cases of allergic reactions to fenugreek known to the scientific community date back to 1997 and were not caused by the ingestion of the spice. In the first case, a housewife with a positive history of mild asthma and chicken allergy developed sneezing, rhinorrhea, eye tearing, and wheezing after opening and smelling a container containing fenugreek. In the second case, a woman with rhinitis and allergic asthma and a previous episode of respiratory wheezing after the ingestion of fenugreek paste applied fenugreek paste to her scalp to treat dandruff. Nasal obstruction and hoarseness appeared after a few minutes, followed by angioedema and respiratory wheezing [35]. In the cases reported by [PERSON], the sensitization occurred at home and therefore had very low amounts of allergen indeed, compared to sensitizations that occur in the case described by [PERSON] in an occupational setting [40]. In addition, in the first case, the patient had a known allergy to chickpeas, so the adverse reaction to fenugreek could have resulted from cross-reactivity with chickpeas.  
\begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline \multicolumn{1}{c}{**Author**} & \multicolumn{6}{c}{**Cases of Fenugreek Hypersensitivity**} \\ \hline \multirow{2}{*}{**Author**} & \multirow{2}{*}{**Article Type**} & \multirow{2}{*}{**Year**} & \multirow{2}{*}{**Age Sex**} & \multirow{2}{*}{\begin{tabular}{c} **Symptoms Associated with** \\ **Fenugreek** \\ \end{tabular} } & \multirow{2}{*}{\begin{tabular}{c} **Previous** \\ **Adverse** \\ **Reactions** \\ \end{tabular} } & \multirow{2}{*}{\begin{tabular}{c} **Other** \\ **Cosensitizations** \\ \end{tabular} } \\ \hline \multirow{4}{*}{\begin{tabular}{c} Bentele- \\ [PERSON] [41] \\ \end{tabular} } & \multirow{4}{*}{Case report} & \multirow{4}{*}{2015} & \multirow{4}{*}{32} & \multirow{4}{*}{F} & Fever, headache and exanthema & & \\  & & & & evolving towards TEN after & & \\  & & & & regular ingestion of an herbal & & \\  & & & & preparation made of pure & & \\  & & & & & fenugreek seeds to improve & & \\  & & & & & lactation. & & \\ \hline \hline \multicolumn{1}{c}{Cases of fenugreek hypersensitivity in patients with peanuts allergy} \\ \hline Author & Article type & Year & \multicolumn{3}{c}{Outcomes} \\ \hline \multirow{3}{*}{\begin{tabular}{c} [PERSON] \\ [42] \\ \end{tabular} } & \multirow{3}{*}{Retrospective study} & \multirow{3}{*}{2011} & \multirow{3}{*}{\
\begin{tabular}{c} The Norwegian Food Allergy Register in 2000–2010 has received 877 reports, of which patients with a known peanut allergy had allergic reactions after spicy sauces and Indian dishes (the reactions were found to be caused by fenugreek seeds, commonly used in curry and other mixed spices). \\ \end{tabular} } \\ \cline{4-5}  & & & &
\begin{tabular}{c} A total of 195 children allergic to peanuts showed simultaneous sensitization to at least one other legume (fenugreek, soy, lupin and lentili; \(n\) = 122–69.7\%); \\  & & 10\% of them were allergic to fenugreek. Main sensitivities were to fenugreek, followed by lentil, soy, pea, lupine, chicken, broad bean, and bean. \\ \end{tabular} \\ \hline \hline \multicolumn{1}{c}{F = female, M = male; Ara h = _Arrachis hprogea_ molecular allergen, Art v = _Artemisia vulgaris_ molecular allergen; TEN = toxic epidermal necrolysis. \\ \end{tabular} } \\ \end{tabular}