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)