The prevalence of legume allergies varies globally and is influenced by dietary habits and genetic factors. In the UK, the prevalence of legume allergies among children varies depending on the specific legume:

• Peanut allergy: Affects approximately 0.61% of children, making it one of the most common food allergies (Emmett et al., 1999).

• Soy allergy: Reported in around 0.4% of the paediatric population (Scientific Advisory Committee on Nutrition, 2020).

• Lentil and chickpea allergies: More common in Mediterranean countries but increasingly recognized in UK children due to dietary diversification (Allergy UK, 2020).

• Lupin allergy: Less common but gaining attention due to its inclusion in food labelling regulations (Anaphylaxis UK, 2019).

While peanut allergy is widely studied, data on other legume allergies in UK children remain limited. Cross-reactivity between different legumes can occur; for instance, a small but significant number of children with peanut allergy are also allergic to lupin (Moneret-Vautrin et al., 2009).

Legume allergies can present with a spectrum of symptoms, ranging from mild oral allergy syndrome to severe anaphylaxis. Common manifestations include urticaria, angioedema, gastrointestinal disturbances, respiratory symptoms, and, in severe cases, anaphylactic shock (Library of Sheffield Children’s NHS, 2025). Cross-reactivity among legumes is possible but not universal; for instance, while some children allergic to peanuts may tolerate other legumes, others may react to multiple legumes (ResearchGate, 2025).

Specific data on the rates of children presenting to emergency services in the UK with anaphylaxis specifically due to legume allergies is limited. However, available studies provide insights into food-induced anaphylaxis in the paediatric population:

• A study analysing UK hospital admissions between 1998 and 2018 found that food-induced anaphylaxis admissions increased from 1.23 to 4.04 per 100,000 population per year, marking an annual increase of 5.7% (95% confidence interval 5.5% to 5.9%, p<0.001) (Baseggio Conrado et al., 2021).

• In a paediatric emergency department setting, the incidence of anaphylaxis presentations was reported as 1 per 1,000 cases, with food being the most common trigger (Pumphrey, 2007).

While these studies highlight the prevalence of food-induced anaphylaxis in children, they do not specify the proportion attributable to legume allergies. Given that peanuts are a common cause of food allergies and anaphylaxis, it is plausible that legumes contribute to these statistics, but precise data is lacking.

Further research focusing on specific allergens, including legumes, is necessary to accurately determine their impact on anaphylaxis cases in UK emergency services.

Accurate diagnosis involves a combination of an allergy-focused clinical history, skin prick testing, serum-specific IgE measurements, and, when necessary, oral food challenges (Library of Sheffield Children’s NHS, 2025). It is essential to assess each legume individually due to variable cross-reactivity. Component-resolved diagnostics can enhance specificity, particularly in distinguishing primary sensitization from cross-reactivity (NCBI, 2025).

Avoidance

Strict elimination of identified allergenic legumes from the diet is necessary. Education on reading food labels is vital, especially since only certain legumes like peanuts, soy, and lupin are required to be declared as allergens on UK food labels (Allergy UK, 2025).

Emergency preparedness

Prescribing adrenaline auto-injectors (AAIs) for patients at risk of anaphylaxis is critical, and ensuring that patients, caregivers and school personnel are trained in their use is essential (Turner et al., 2024). Notably, a study highlighted that approximately one-third of children with life-threatening food allergies in the UK had not been prescribed AAIs, underscoring the need for improved prescribing practices (Turner et al., 2024).

Regular follow-up

Monitoring for potential development of tolerance is recommended, particularly in younger children, as some may outgrow certain legume allergies over time (Library of Sheffield Children’s NHS, 2025).

Healthcare professionals should:

• Maintain a high index of suspicion for legume allergies in children presenting with compatible symptoms.

• Provide comprehensive education to families on avoidance strategies and emergency management.

• Advocate for accurate food labelling and increased awareness of less commonly recognized legume allergens.

• Collaborate with schools to ensure safe environments for allergic children, including access to emergency medication.