Although clinical cross-reactivity between nuts may be difficult to establish, the possibility of exhibiting symptoms of food allergy to multiple nuts plays an important role in the management of patients allergic to nut, especially for children who are of an age where identification of individual nuts is incomprehensible. The summary of nut cross-reactivity is given in Table 1. It is common to find positive testing (skin prick or serum-specific IgE) to other legumes in those patients with history of clinical reaction to peanut. A study of 62 children with legume allergy found 79% of patients with serologic evidence of IgE binding to at least one additional legume and 37% had IgE binding to all six legumes tested, including peanut, soybean, lima bean, pea, garbanzo bean, and green beans.41,42 Despite this common finding of cross-sensitization, the rate of clinical allergy to multiple legumes is much lower. This has been demonstrated in multiple studies of children with peanut allergy, in which double-blind, placebo-controlled OFCs were used to assess clinical reactivity to soy.43,44 Although a good proportion (up to 31%) of patients allergic to peanut exhibited a positive skin test result to soy, significantly fewer children had clinical reactivity to both legumes (only 1%–3%). Another study of children with atopic dermatitis showed no reaction to any other legumes tested in children sensitive (skin test positive) to peanut.43