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.