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A practical focus on oral immunotherapy to tree nuts.

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Tree nut (TN) allergy affects many globally and is often persistent. Tree nut oral immunotherapy (OIT) is a safe and effective treatment option for patients diagnosed with TN allergy.

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Area of Science:

  • Allergy and Immunology
  • Clinical Nutrition
  • Food Science

Background:

  • Tree nut (TN) allergy is a prevalent global health concern, affecting up to 4.9% of the population.
  • TN allergy is typically persistent, with accidental reactions being common, necessitating effective management strategies.
  • Clinical cross-reactivity exists between specific tree nuts, such as cashew and pistachio, and walnut and pecan.

Purpose of the Study:

  • To review the diagnosis and management of tree nut allergy.
  • To evaluate the safety and efficacy of tree nut oral immunotherapy (OIT).
  • To highlight OIT as a recommended treatment option for tree nut allergy.

Main Methods:

  • Diagnosis relies on clinical history of reaction to ingestion and sensitization confirmation via skin-prick or serum immunoglobulin E (IgE) testing.
  • Component testing and food challenges may be employed, particularly in patients with birch pollinosis, to differentiate allergy types.
  • Evidence supporting the safety and effectiveness of TN OIT was reviewed.

Main Results:

  • Tree nut oral immunotherapy (OIT) has demonstrated reasonable safety and effectiveness in available evidence.
  • Various nonpharmaceutical products are available to assist with TN OIT dosing.
  • OIT is presented as a viable treatment option for individuals with tree nut allergy.

Conclusions:

  • Tree nut allergy is common, persistent, and requires careful diagnosis, potentially involving component testing for specific populations.
  • Tree nut oral immunotherapy (OIT) is a safe and effective treatment option supported by available evidence.
  • It is recommended that tree nut OIT be offered to patients diagnosed with tree nut allergy.