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Background Legume consumption has increased during the two past decades. In France, legumes are responsible for 14.6% of food‐related anaphylaxis in children, with peanut as the main allergen (77.5%). Few studies have demonstrated cross‐reactivities between peanut and other legumes. The aim of this study was to determine prevalence and relevance of sensitization to legumes in peanut‐allergic children. Methods All children, aged of 1–17 years, admitted to the Pediatric Allergy Department of the University Hospital of Nancy between January 1, 2017 and February 29, 2020 with a confirmed peanut allergy (PA) and a documented consumption or sensitization to at least one other legume were included. Data were retrospectively collected regarding history of consumption, skin prick tests, specific immunoglobulin E (IgE), prior allergic reactions, and oral food challenges for each legume. Results Among the 195 included children with PA, 122 were sensitized to at least one other legume (63.9%). Main sensitizations were for fenugreek (N = 61, 66.3%), lentil (N = 38, 42.2%), soy (N = 61, 39.9%), and lupine (N = 63, 34.2%). Among the 122 sensitized children, allergy to at least one legume was confirmed for 34 children (27.9%), including six children who had multiple legume allergies (4.9%). Lentil, lupine, and pea were the main responsible allergens. Half of allergic reactions to legumes other than peanut were severe. Conclusion The high prevalence of legume sensitization and the frequent severe reactions reported in children with PA highlight that tolerated legume consumption should be explored for each legume in the case of PA, and sensitization should be investigated if not.

Background: Cashew nut (CN) allergy prevalence has increased over the last few years. In children allergic to CN, complete avoidance of pistachio is usually recommended, but recent study showed that only one third of children allergic to CN were also allergic to pistachio. The aim of our study was to identify predictive factors of allergy to pistachio in children allergic to CN. Methods: All children who had a positive oral food challenge (OFC) to CN between November 2013 and October 2017 in the Paediatric Allergy Department of the University Hospital of Nancy were included. Logistic regression models were used to predict the probability of allergy to pistachio.Results: Among the 147 children included, tolerance or allergy to pistachio was known for 51. Out of these, 40 were allergic to pistachio (78.4%). Children allergic to pistachio had a larger weal size of skin prick test to CN (P = .01) and pistachio (P = .0007) and a lower reaction dose to CN (P < .0001). In multivariate analysis, only the reaction dose to CN was significantly associated with allergy to pistachio.Children with a low reaction dose to CN were significantly more at risk to have an allergy to pistachio (P = .01). Conclusion:A low reaction dose to CN seems to be a predictive factor of allergy to pistachio in children allergic to CN. In order to limit unnecessary food eviction, a pistachio OFC should be performed in children having high reaction dose whatever the importance of the skin or the specific IgE sensitization to pistachio. K E Y W O R D S allergy, cashew nut, children, pistachio, threshold dose, tree nut 1 | INTRODUC TI ON Cashew nut (CN) allergy prevalence has increased in the last few years. In a recent study on 1045 positive oral food challenges (OFCs), CN was the second most common allergen, after peanut. 1 In the SchoolNuts study, CN allergy was the most frequent tree nut (TN) allergy. 2 CN can cause immediate anaphylactic reaction even more severe than peanut. 3,4 CN allergy, along with other TN allergies, appears around the age of two, when CN and pistachio are introduced into the child's diet. 5 | 507 SABA et Al.CN and pistachio belong to the same botanical family called the anacardiaceae 6 ; therefore, the avoidance of pistachio is also currently recommended in case of allergy to CN. Avoidance of TN is becoming more and more difficult to realize. The presence of CN and pistachio in very low doses is difficult to eliminate, due to cross-contamination in food lines. 7 Moreover, the consumption of CN and pistachio has increased in the past few years due to the changes in food habits, and they are now used in products such as snacks, butters, pesto, bakery, and confectionary items. 8In vitro reactivity between CN and pistachio has been established by specific IgE (sIgE) inhibition tests. 9 Willison et al 10 demonstrated that Ana o 1 (specific CN protein) and Pis v 3 (specific pistachio protein) had large structural homologies. Moreover, Uotila et al 11 reported that pistachio and CN had one of the strongest co-sensitization linkag...

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