Soy Allergy: Overview, Diagnosis, and Treatment

About Soy Allergy

Soy is recognized as one of the big eight food allergens and soy allergy usually manifests in childhood.¹While it’s estimated that approximately 0.4 percent of children are allergic to soy, approximately 70 percent of pediatric patients are likely to outgrow their soy allergy by age 10.^2,3 Allergic reactions to soy in adults are rare; the prevalence of soybean allergy in adults has been estimated to be less than 0.5 percent of the general population.^1,4

Food allergy to soy has been described primarily in young children with atopic dermatitis, who often outgrow their soy allergy after one to two years of dietary elimination.^2,5,6Atopic dermatitis is not the only soybean-induced allergic symptom; Cutaneous, respiratory, and gastrointestinal symptoms are common, but severe systemic reactions, including fatal anaphylaxis, have also been reported.^1,4,6 However, anaphylaxis caused by soy is very rare.¹

Although soy is recognized as one of the big eight food allergens, it is uncommon to see allergic reactions exclusive to soy, rather, it is often found in patients who are allergic to multiple foods and birch pollen.¹

70% of pediatric patients

Approximately 70 percent of pediatric patients are likely to outgrow their soy allergy by age 10.^2,3

Common soybean-induced allergic symptoms:^1,4,6

Cutaneous symptoms
Respiratory symptoms

Gastrointestinal symptoms
Anaphylaxis (however, anaphylaxis caused by soy is very rare¹)

Isolated soy allergy seems to be a rare occurrence; for example, 88 percent of children with soy allergies also have peanut allergies.¹

Soy allergy: Refining differential diagnosis through testing

Like all food allergies, diagnosing an allergy to soy starts with a physical examination and, of critical importance, a food-allergy-focused patient history.^7,8

The findings of this patient history can then be used to guide testing decisions and results interpretation. This systematic approach can help determine whether the reported history of food allergy, combined with laboratory data such as specific IgE testing, is sufficient to diagnose soy allergy or determine whether an oral food challenge should be considered.⁹

Who should be tested?

Identifying individuals with soy allergy is important, as many processed foods contain soy.² Soy protein is one of the most common pediatric food allergens, and is also an important source of nutrition for infants with a cow’s milk allergy.² Therefore, soy avoidance is challenging for patients with soy allergy.²

Isolated soy allergy seems to be a rare occurrence; for example, according to one study, 88 percent of children with soy allergies also have peanut allergies.¹ Plus, about 6 percent of atopic children and 10 percent to 14 percent of infants with a cow's milk allergy also suffer from concomitant soy allergy.¹

Click to View Algorithm¹⁰

The evaluation for a patient with a possible food allergy begins with a thorough history and physical exam. If the clinical history suggests an IgE-mediated food allergy, skin-prick or specific IgE tests are needed to help confirm the diagnosis.

Soy allergy and quality of life

Food allergy, including soy allergy, and can have a dramatic effect on quality of life.¹¹ Many studies have detailed the negative effect of food allergy on health-related quality of life (HRQoL), as well as the financial and emotional toll a food allergy takes.⁹ Identified issues include feeling different because of the diet, worrying about foods, the presence of physical and emotional distress, increased responsibility, effect on social activities (social restrictions, school, travel, and dining out), anxiety, stress, bullying, and having to consistently exercise greater caution.⁹

Hidden soy allergens

Soy is so widely distributed in processed foods that avoidance of soy is very difficult.¹² Because of the nearly unlimited uses of soy, it is a particularly insidious hidden allergen.¹²

Soy can be used in the manufacture of food in a great variety of ways, including as a “texturizer,” emulsifier, and protein filler.¹² The majority of breads contain some soy flour and so may pastries, cakes, biscuits, and baby foods.¹² It is also used in the manufacture of sausages, processed meats, hamburgers, and other meat products.¹²And soy is a popular vegetarian meat substitute in vegetarian products and in catering establishments, including hospital and army food services, and feeding programs.^2,12 Other foods that may contain soy include pureed and cereal baby foods, and margarine.¹²

Testing Confidence

Testing Increases Diagnostic Confidence

Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.^i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.^i,iiDiagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.^iii,iv

^{i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.

ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331

iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.

iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238}

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Management and care of patients with soy allergy

Strict avoidance of the allergenic food is the cornerstone of management for individuals with food allergy, including soy.¹³ While this is seemingly straightforward, adhering to strict avoidance may be challenging as soy is frequently hidden in foods.^12,13

Keeping a patient with soy allergy safe is contingent on frequent label reading, preventing cross-contact, providing anticipatory guidance to caregivers regarding reaction severity and treatment, and the patient or caregivers effectively communicating with restaurant staff when eating outside of the home.¹³ Label reading alone requires constant vigilance due to changing manufacturing practices over time.¹³

Practice parameters have been developed to help guide the management and treatment of patients with food allergies, including soy.

Practice parameters and guidelines

for soy allergy:

Summary of the New Food Allergy Guidelines for Primary Care Physicians (January 2012)

Summary of the New Food Allergy Guidelines for Pediatricians (September 2011)

European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines

National Institute for Health and Care Excellence (NICE) food allergy guideline

Management of food allergy in the school setting (AAP clinical report, 2010)

Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel (2010)

Food allergy: a practice parameter update (2014)

Read Patient Case Studies

References

Masilamani M, Commins S, Shreffler W. Determinants of Food Allergy. Immunol Allergy Clin North Am. 2012 February; 32(1): 11–33.
Savage JH et al. The natural history of soy allergy. J Allergy Clin Immunol. 2010 Mar;125(3):683-6.
Abrams EM, Sicherer SH. Diagnosis and management of food allergy. CMAJ. 2016 Oct 18; 188(15): 1087–1093.
Kleine-Tebbe J et al. Severe oral allergy syndrome and anaphylactic reactions caused by a Bet v 1– related PR-10 protein in soybean, SAM22. J Allergy Clin Immunol. 2002 Nov;110(5):797-804.
Mittag D et al. Soybean allergy in patients allergic to birch pollen: Clinical investigation and molecular characterization of allergens. J Allergy Clin Immunol. 2004 Jan;113(1):148-54.
Holzhauser T et al. Soybean (Glycine max) allergy in Europe: Gly m 5 (b-conglycinin) and Gly m 6 (glycinin) are potential diagnostic markers for severe allergic reactions to soy. J Allergy Clin Immunol. 2009 Feb;123(2):452-8.
Kurowski K, Boxer RW. Food allergies: detection and management. Am Fam Physician. 2008;77:1678-1688.
Burks AW, Tank M, Sicherer S, et al. ICON: Food allergy. J Allergy Clin Immunol. 2012;129:906-920.
Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018 Jan;141(1):41-58.
Kattan JD, Sicherer SH. Optimizing the diagnosis of food allergy. Immunol Allergy Clin North Am. 2015 Feb;35(1):61-76. doi: 10.1016/j.iac.2014.09.009. Epub 2014 Nov 21. PMID: 25459577; PMCID: PMC4644667.
Antolín‐Amérigo et al. Quality of life in patients with food allergy. Clin Mol Allergy. 2016;14:4.
Steinman HA. "Hidden" allergens in foods. J Allergy Clin Immunol. 1996 Aug;98(2):241-50.
Bird JA, Lack G, Perry TT. Clinical Management of Food Allergy. J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):1-11; quiz 12.

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