Tree Nut Specific Immunotherapy
Sublingual Immunotherapy (SLIT) (Table 3)
Initially, Enrique et al.14 investigated the efficacy of hazelnut-SLIT in 12 allergic patients. After 2-3 months of therapy, the ED increased from 2,29g to 11,56g, and 5 participants reached the highest dose (20g of hazelnut), compared with 1 in placebo. Systemic reactions occurred in 0,2% of doses (3 reactions in 2 patients, one of each group), only during the build-up phase. Local reactions, mainly immediate oral itching, were observed in 7,4% doses. Four patients in treatment reported abdominal pain during the build-up phase. All reactions during the maintenance phase were oral itching, in the same patient.
In the follow-up study34, seven patients were reassessed after a year with hazelnut-SLIT. Three discontinued after 4 to 6 months. There was a further increase in ED to 14,57g, and five patients reached the highest dose. One patient, who had tolerated the highest dose at the original study, lost protection one year after. Less than 2% of patients reported oral itching. No systemic or gastrointestinal reactions were reported.
Recently, Beitia et al24 prospectively assessed the effect of 1-year Pru p 3-SLIT on 29 patients with LTP-syndrome, including 5 patients with allergy to almond, 5 to walnut, 10 to hazelnut, and 1 to cashew. Of them, 4 discontinued treatment before the first year. Authors reported the results of three final OFCs with hazelnut; 1 was successful. Of the overall 29 participants, 10,3% discontinued due to adverse reactions and 72,4% reported mild oral pruritus during the first weeks, which required no treatment.
Oral Immunotherapy (Table 4)