A practical focus on legume oral immunotherapy

Legumes other than peanut are an important source of protein and consist of a wide variety of species, such as soy, peas, chickpeas, lentils, and lupin. Due to their health benefits and the rising popularity of veganism, legume consumption has increased. Legume allergy, cross-sensitization, and cross-reactivity between different species have been reported in the literature and are increasingly recognized. Unlike peanut, oral immunotherapy (OIT) for nonpeanut legumes has not been well studied and published protocols are lacking. Future studies are needed to provide real-world data on the safety and effectiveness of nonpeanut legume OIT, and whether desensitization to one legume leads to desensitization to other legumes in patients with multiple legume allergy. Nevertheless, due to the abundance of clinical trial and real-world data for peanut OIT, it is reasonable to use protocols that substitute peanut protein with other legume protein when desensitizing individuals with nonpeanut legume allergy. Clinicians who are starting to offer legume OIT in their practices may consider starting with preschoolers, an age group for whom real-world data has shown the greatest safety and effectiveness.