Soy Allergy Nuance: Differentiating between a clinical soy allergy and a pollen-related soy allergy

Anna and Oliver, both 8 years old, have a history of birch and soy allergy, both visit their healthcare provider after experiencing rhinitis during pollen season and dry skin.

Anna and OIiver's healthcare provider conducts a full clinical history and physical examination of them both and decides to test using soy components.

Two kids have a history of birch and soy allergy and visit their healthcare provider after experiencing dry skin and rhinitis during pollen season.

Patient History

Family History

None

Anna and Oliver's Personal History

Eczema during infancy, rhinitis.

Skin Prick Test
Test	Type	Anna's Results	Oliver's Results
Egg	Whole Allergen	0	0
Milk	Whole Allergen	0	0
Soy	Whole Allergen	+2	+2
Wheat	Whole Allergen	0	0
Fish	Whole Allergen	0	0
Birch	Whole Allergen	+2	+1
Timothy grass	Whole Allergen	0	0

Anna and Oliver's previous healthcare provider diagnosed them with birch and soy allergies. She recommended the use of oral antihistamines during birch pollen season and directed them to avoid soy and soy products.

Anna and Oliver’s ImmunoCAP™ Test Results

These results together with this patient's case history and symptoms, help confirm the diagnosis.

ImmunoCAP Test Results (kU_A/I)
Test	Type	Anna’s Results	Oliver’s Results
Soy	Whole Allergen	0.8	24
Gly m 4	Allergen Component	15	2.5
Gly m 5	Allergen Component	<0.1	16.2
Gly m 6	Allergen Component	<0.1	6.7
Birch	Whole Allergen	58	20

Differential Diagnosis

Anna

Anna’s results indicate a clinically relevant cross-reaction between birch pollen and soy. Specific IgE antibodies to Gly m 4 are often associated with local reactions. However, systemic reactions may occur, particularly when consuming high amounts of low processed soy, e.g., soy milk. If clinical history is unclear, it may be advisable to proceed with a food challenge to confirm the diagnosis of soy allergy.¹

REFINED DIAGNOSIS

Birch allergy is confirmed, with a likely pollen-related allergy to soy.

HEALTHCARE PROVIDER MANAGEMENT PLAN

Anna's healthcare provider advises her:

To avoid large amounts of soy, e.g., soy milk.
That she has no strict dietary restrictions on soy and should not be stressed about the risk of eating “hidden” soy.
To continue using antihistamine and nasal steroids during pollen season.

FOLLOW UP

Anna with her mother visit her healthcare provider one year later. Anna is doing well.

Oliver

Oliver’s results indicate his level of sensitization to Gly m 5 put him at an increased risk of severe reaction if soy is ingested, even small amounts.¹

REFINED DIAGNOSIS

Soy and birch allergy was confirmed.

HEALTHCARE PROVIDER MANAGEMENT PLAN

Oliver's healthcare provider advises him:

To continue to avoid soy in all forms and always carry his emergency adrenaline autoinjector.
To get follow-up education and training on autoinjector use for Oliver and his family.
To continue using antihistamine and nasal steroids during pollen season.

FOLLOW UP

Oliver with his mother visit his healthcare provider one year later. He is fit and well. Oliver's healthcare provider checks his autoinjector technique and is satisfied.

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