INTRODUCTION/BACKGROUND
Tree nuts belong to the group of the eight major allergenic foods and,
along with peanuts, have been implicated in severe fatal or near-fatal
allergic reactions1. However, allergic manifestations
to nuts vary substantially, ranging from benign oropharyngeal symptoms
to life-threatening anaphylaxis, depending on several factors, such as
the implicated nut2,3, the sensitization to distinct
allergen components, the presence of co-factors4-7,
and even the process of the nuts before consumption8.
Unlike peanut allergy, allergy to tree nuts has been under-investigated.
Evidence on the prevalence, clinical manifestation, and natural history
of tree nut allergy is generally sparse, as has been recently
reviewed4,5,9. Recent studies10,11suggest that, in many countries, allergy to tree nuts is more common
than peanut. As with other foods, the management of tree nut allergy
involves strict avoidance of the culprit nut (and often of potentially
cross-reacting foods) and symptomatic treatment of accidental
consumption. Food oral immunotherapy (OIT) is actively investigated for
the management of milk, egg, wheat, and peanut allergy. FDA, EMA, and
NICE have recently approved peanut OIT for clinical practice. On the
contrary, there is a lack of data on desensitization approaches in
managing tree nut allergy. This systematic review aims to evaluate
potential therapeutic options for desensitization of patients with
IgE-mediated tree nut allergy.