Clinical Experience
IgE-mediated reactions
Anecdotal evidence suggests that fenugreek may induce symptoms of food allergy in sensitised individuals; however, few studies have been reported to date. (6, 11) It is possible that the allergy occurs more frequently than has been reported.
Reactions may follow ingestion, inhalation or external application of fenugreek seed powder. Two cases of immediate severe allergy to fenugreek have been described. In the first case, inhalation of the fenugreek seed powder resulted in rhinorrhea, wheezing and fainting. The second case was of a patient with chronic asthma who developed numbness of the head, facial angioedema, and wheezing after application of fenugreek paste to her scalp as a treatment for dandruff. Skin reactivity was detected to fenugreek and chickpeas. During double-blind, placebo-controlled food challenge, both patients showed a > 20% drop in peak flow rate after consumption of fenugreek and chickpea. (2)
Anaphylaxis to curry powder was described in a 26-year-old nurse who presented with bronchospasm. Her initial symptoms were generalised itching, diarrhoea and stridor which were reproduced 20 minutes later following an oral challenge of curry and rice. The causative allergens were narrowed down to cardamom and fenugreek. Serum IgE antibodies to both were high. (12)
An Algerian student using fenugreek powder orally as an appetite stimulant and topically as a healing agent was reported to have rhinitis and asthma as a result of handling the powder. A prick test with fenugreek powder was strongly positive. (13)
Fenugreek has also been reported to result in occupational asthma. (14)
This study describes a patient, working in a spice factory, with anaphylaxis from coriander in a meal. He also demonstrated urticaria, angioedema, rhinoconjunctivitis and bronchospasm during handling coriander and fenugreek. SPT, serum IgE antibodies and basophil activation tests were clearly positive in the patient. No cross-reactivity between fenugreek and coriander was demonstrable by inhibition experiments. (15)
Other reactions
The seed contains 1% saponins. Although poisonous, saponins are poorly absorbed by the human body, and so most pass through without harm. Only large amounts tend to be dangerous. Leaching or thorough cooking will remove most saponins.
Non-steroidal anti-inflammatory drugs, particularly aspirin, have the potential to interact with herbal supplements containing coumarin (e.g. fenugreek), resulting in bleeding (16) or potentiation of the effects of warfarin therapy. (17, 18)
Fenugreek, maple syrup, and the urine of maple syrup urine disease patients all share a characteristic odour (‘maple syrup’ urine odour), originating from a common component, sotolone. (19, 20, 21, 22) Maple syrup urine disease is an autosomal recessive inherited disorder of amino acid metabolism. The disease gives a characteristic sweet aroma, reminiscent of maple syrup, to the body fluids (e.g. urine) of affected patients. The substance responsible for the odour is 4,5-dimethyl-3-hydroxy-2[5H]-furanone (sotolone), a compound also present in fenugreek and lovage. (23) Ingestion of fenugreek by mothers during labour resulted in a maple syrup-like odour in their newborn infants, leading to a false suspicion of maple syrup urine disease. (17)