ORCID ID:
MP: 0000-0001-6658-4828
PX: 0000-0002-4448-3468
AGM: 0000-0002-4675-9616
JL: 0000-0003-0869-736X
EE: 0000-0002-0332-6810
NGP: 0000-0002-4448-3468
Conflict of Interest: MP, PX, AGM, JL, EE, and NGP declare no
conflicts of interest.
Acknowledgments: This
work was supported by grants from the Hellenic Society of Allergology
and Clinical Immunology and was co-financed by Greece and the European
Union (European Social Fund-ESF) through the Operational Programme
“Human Resources Development, Education and Lifelong Learning” in the
context of the Act “Enhancing Human Resources Research Potential by
undertaking a Doctoral Research” Sub-action 2: IKY Scholarship
Programme for PhD candidates in the Greek Universities. AGM was
supported by the National Institute for Health and Care Research
Manchester Biomedical Research Centre (NIHR Manchester BRC) and by an
NIHR Clinical Lectureship in Respiratory Medicine.
Keywords: Allergy treatment, food allergy, immunotherapy,
management, tree nuts
Abstract: This systematic review evaluates the potential
therapeutic options for desensitization of patients with IgE-mediated
tree nut allergy, focusing, but not limited to, on immunotherapy. We
searched three bibliographic databases for studies published until July
2022 for active treatments of IgE-mediated allergy to tree nuts (walnut,
hazelnut, pistachio, cashew, and almond) with allergen-specific
immunotherapy (AIT) using oral (OIT), sublingual (SLIT), epicutaneous
(EPIT) or subcutaneous (SCIT) delivery, or with other disease-modifying
treatments. We included 26 studies, but the heterogeneity of the studies
prevented pooling and meta-analysis. Immunotherapy with hazel pollen
extracts might benefit patients with a secondary nut allergy due to
cross-reactivity with PR-10 or profilin panallergens but is unlikely to
be beneficial in patients with a severe nut allergy caused by seed
storage proteins. Sublingual immunotherapy has a moderate efficacy but a
favorable safety profile. Oral immunotherapy (OIT), single, or
multi-nut, with or without omalizumab, is the most studied approach. In
general, tree nut OIT is effective in conferring protection from
accidental exposures, with safety similar to that demonstrated by peanut
OIT. The observed cross-desensitization between tree nuts straightly
affects the management options for multi-nut allergic patients.