Exploiting nut cross-reactivity to facilitate real-world treatment of tree nut allergy

Wasserman, Richard L.; Windom, Hugh; Lie, Daria; Pence, Deanna M.; Ly, Jean

doi:10.1016/j.anai.2021.04.010

Cited by 9 publications

(15 citation statements)

References 11 publications

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“…20 While successful cashew desensitization was recently described in a real-world cashew OIT, the study was retrospective and uncontrolled, and the failure rate and the rate of adverse reactions during treatment were not provided. 19 Our study is the first to demonstrate the high rate of cashew desensitization following cashew OIT. The results of this study are comparable to previously described walnut, peanut, and sesame OIT studies.…”

Section: Discussionmentioning

confidence: 65%

“…We recently described our results in patients undergoing walnut OIT and achieved desensitization rate of 89% 20 . While successful cashew desensitization was recently described in a real‐world cashew OIT, the study was retrospective and uncontrolled, and the failure rate and the rate of adverse reactions during treatment were not provided 19 . Our study is the first to demonstrate the high rate of cashew desensitization following cashew OIT.…”

Section: Discussionmentioning

confidence: 76%

“…In another report, most patients could tolerate pistachio following cashew OIT but many of them had not been challenged to pistachio before treatment. 19 We demonstrate that patients with co-allergy to pistachio, based on history of a recent reaction or a positive food challenge, were all desensitized to pistachio following successful cashew OIT. We also show that pistachio desensitization was associated with markers immunological tolerance.…”

Section: Discussionmentioning

confidence: 77%

“…18 In a recent report of a real-world study, cashew OIT was successful in desensitizing both cashew and pistachio. 19 However, the study was retrospective and uncontrolled, some patients were co-treated with other tree nuts (walnut), and most patients were not challenged to pistachio before cashew OIT.…”

Section: Introductionmentioning

confidence: 99%

“…A multi‐food OIT study including patients with cashew allergy reported successful desensitization to cashew in conjunction with omalizumab, while most patients who were not simultaneously treated with omalizumab failed 18 . In a recent report of a real‐world study, cashew OIT was successful in desensitizing both cashew and pistachio 19 . However, the study was retrospective and uncontrolled, some patients were co‐treated with other tree nuts (walnut), and most patients were not challenged to pistachio before cashew OIT.…”

Section: Introductionmentioning

confidence: 99%

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Cashew oral immunotherapy for desensitizing cashew‐pistachio allergy (NUT CRACKER study)

Elizur

Appel

Nachshon

et al. 2022

Allergy

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Background Oral immunotherapy (OIT) is a treatment option for patients with milk, egg, and peanut allergy, but data on the efficacy and safety of cashew OIT are limited. Methods A cohort of 50 cashew‐allergic patients aged ≥4 years, who were consecutively enrolled into cashew OIT (target dose 4000 mg protein) between 4/2016 and 12/2019. Fifteen cashew‐allergic patients who continued cashew elimination served as observational controls. Co‐allergy to pistachio and walnut was determined. Full desensitization rate and associated immunological changes in both groups were compared. Patients fully desensitized to cashew were instructed to consume a dose of 1200 mg cashew protein for 6 months and were then challenged to a full dose. Patients with co‐allergy to pistachio or walnut were challenged to the respective nut. Results Forty‐four of 50 OIT‐treated patients (88%) compared to 0% in controls tolerated a dose of 4000 mg cashew protein at the end of the study (odds ratio 8.3, 95% CI 3.9–17.7, p < 0.001). An additional three patients were desensitized to 1200 mg cashew protein, and three patients stopped treatment. Three patients (6%) were treated with injectable epinephrine for home reactions. Desensitized patients had decreased SPT, sIgE, basophil reactivity, and increased sIgG4, following treatment. Following cashew desensitization, all pistachio (n = 35) and four of eight walnut co‐allergic patients were cross‐desensitized to the respective nut. All (n = 44) patients consuming a low cashew dose for ≥6 months following desensitization passed a full‐dose cashew OFC. Conclusions Cashew OIT desensitizes most cashew‐allergic patients and cross‐desensitizes to pistachio. Safety is similar to OIT for other foods.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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