Fenugreek Allergy in Children: Prevalence in Sensitized Children and Diagnostic Values of Skin Prick Test and Specific IgE

In the past 25 years, several cases of fenugreek allergy have been reported, mostly in adults and most of the times associated with peanut allergy. The main objectives of our study were to evaluate the prevalence and severity of allergy to fenugreek in sensitized children and determine diagnostic values of skin prick-test (SPT) and specific IgE. A retrospective observational study was conducted. All children sensitized to fenugreek and who underwent a fenugreek oral food challenge (OFC) in the Pediatric Allergy Department of the University Hospital of Nancy between January 2017 and March 2022 were included. Data collected were demographic characteristics, atopic comorbidities, SPT, sIgE, prior allergic reactions, and OFC to fenugreek. Among the 46 children included, OFC was positive for 10 children (21.7%), with a median cumulative reactogenic dose of 96.9 mg [58.3–135.5] and 60% of severe allergic reactions. Positive predictive values for SPT and specific IgE to fenugreek were respectively 40% for 11 mm and 28.6% for 22 kU/L. All children had a relevant peanut allergy. Children with fenugreek allergy had a significant higher SPT value to fenugreek than children sensitized but tolerant (P = 0.02). In children sensitized to fenugreek, one in five had a confirmed allergy, mostly with a severe reaction. As diagnostic values of SPT and sIgE are low, OFC is needed in case of sensitization. Sensitization to fenugreek should be systematically explored in children with peanut allergy and fenugreek allergy cases should be reported to the anaphylaxis registry, in order to increase knowledge.