Single Tree Nut
Bradatan et al.21 reported the results of 37 children
treated with tree nut/peanut-OIT for up to two years, to reach a target
daily dose of 4gr of nut/peanut. At 18 months 25 passed an OFC to their
respective tree nut. Three peanuts-, two cashew- and one hazelnut-OIT
children withdrew early because of allergic side effects. Most of the
reactions reported during the maintenance phase were transient and
required no treatment.
The NutCRACKER study22 described the results of walnut
OIT in 55 walnut allergic children; 49 reached maintenance (4000mg of
walnut protein) and were considered desensitized, three increased their
ED and were considered partially desensitized, and three did not
complete treatment (one due to anaphylactic reactions). At least one
adverse reaction was reported by 47 children at the hospital up-dosing,
and by 40 at the home-dosing, mostly mild, with respiratory and
gastrointestinal symptoms. Epinephrine was administered to 11 children
at the hospital and 8 at home. Three had symptoms compatible with
oral immunotherapy-induced
gastrointestinal-and-eosinophilic responses (OITGER), which subsided
with temporary dose reduction. Nine children of the control group began
OIT, seven were desensitized and were included in the subsequent
analysis. After achieving walnut desensitization at 4000mg the
maintenance dose decreased to 1200mg daily. 45 participants followed up
for at least six months, 11 reported mild allergic reactions requiring
antihistamines, and one required epinephrine. After six months, all
successfully consumed a single dose of 4000mg of walnut protein.
The results of a low-dose walnut-OIT in 3 children were recently
reported by Sasamoto et al.37. Children received an
individualized home starting dose and gradually reached the maintenance
dose of 75mg of walnut protein after 3, 4, and 3 months respectively.
The overall adverse reaction rate per intake at home dosing was 3.1%,
including two anaphylactic reactions. No epinephrine use was required.
Hazelnut-OIT was first described by Morally et al.32in a retrospective study of 100 children. After six months on an
individualized up-dosing protocol to a low maintenance dose (half of
baseline ED), 34 were desensitized to a cumulative dose of 1635mg
hazelnut. Median ED increased by 417mg. The remaining 66 children had at
least doubled their baseline ED at six months. Side effects were
retrospectively reported by 76 children; 30 reported at least one
non-severe reaction. Symptoms suggesting
eosinophilic esophagitis (EoE) or
serious side effects were not reported.
Sabouraud et al.33 reviewed the medical records of 70
children undergoing hazelnut-OIT, including four children with hazelnut
sensitization, but no history of ingestion. At baseline, a low-dose OFC
with hazelnut was used to establish an individualized, intermediate,
6-months target dose. The procedure was repeated every 6 months until a
final individualized dose was reached. At 1 year, 16 children had
reached maintenance, and 36 ingesting >120mg of hazelnut
protein. The cumulative reaction dose increased from 13mg to 741mg. 40
children had at least 1 adverse effect at home, of which half were mild,
17 developed hazelnut aversion, and 14 reported recurrent abdominal
pain. Severe systemic reactions were reported by two children, one of
whom required epinephrine. Among 212 OFCs performed, seven severe
systemic reactions were recorded, with four requiring epinephrine. One
child developed EoE.
Cashew-OIT was described by Elizur et al.25 in 50
cashew-allergic patients. At a median time of 12 months, 44 reached the
target dose of 4000mg cashew protein and were considered fully
desensitized, three tolerated 1200mg and considered partially
desensitized, and three discontinued. The 44 desensitized participants
were instructed to consume daily 1200mg of cashew protein. After 6
months they were all successfully challenged to 4000mg. At the
in-hospital build-up 44 participants experienced at least one allergic
reaction, mainly mild to moderate, while epinephrine was required in 9
participants. At home dosing, 26 participants reported allergic
reactions, mostly mild, and three reported epinephrine administration.
One patient developed OITGER symptoms and one developed EoE.