Latest Developments in the Management of Nut Allergies

Abstract

Purpose of review In this review, we sought to describe the most recent advances in the dietary and medical management of peanut and tree nut allergy, including selective introduction and immunotherapy. Recent findings Dietary updates include changes to labeling laws, improved information sources, and new apps for buying foods in shops and overseas to better protect individuals with nut allergies. There are still issues in the management of nut allergies in schools, such as parents having to resort to packed lunches instead of school meals and patients experiencing bullying. Air travel also poses concern, but additional resources are now available to travelers, and recent evidence suggest limited airborne exposure to nuts. The medical management of anaphylaxis is use of epinephrine; however, this remains underutilized. Needle length and administration devices have been recently debated considering the risk of bone penetration vs subcutaneous administration, and autoinjectors seem to deliver higher peak concentrations than syringes. Selective nut introduction has gained momentum in the last 5 years, demonstrating improved quality of life but with the need for motivated parents for continued consumption and available resources for challenges. Immunotherapy to nuts is also a rapidly developing field, with the balance of efficacy and safety being important considerations in the differing modes of administration. Summary The management of nut allergies is a rapidly developing field, and dietary and medical management have progressed significantly in the last 5 years. Future research directions include improving safety and efficacy of food immunotherapy and examining patients’ goals for therapy and treatment outcomes.

Oral immunotherapy in alpha‐gal red meat allergy: Could specific IgE be a potential biomarker in monitoring management?

“…Food immunotherapy as a new management strategy has emerged especially for milk and peanut allergy in children to enable the patient to eat the allergenic food without reactions. 19,21 Several terms related to food immunotherapy have been proposed. 21 In our study, since regular consumption of RM was advised and long-term tolerance was not demonstrated with long periods of food abstinence in our patients, we still preferred to use the term 'immunotherapy' instead of 'desensitization' since it is more commonly used.…”

“…19,21 Several terms related to food immunotherapy have been proposed. 21 In our study, since regular consumption of RM was advised and long-term tolerance was not demonstrated with long periods of food abstinence in our patients, we still preferred to use the term 'immunotherapy' instead of 'desensitization' since it is more commonly used. Besides, in similar studies which did not assess the food abstinence period, OIT was the preferred term.…”

“…Patients with non-immunological adverse reactions to mammalian meat, uncontrolled asthma, uncontrolled diabetes and uncontrolled heart disease and also those who did not give informed consent were excluded from the study. 21 Anaphylaxis was diagnosed based on the World Allergy Organization (WAO) definition. The severity of systemic allergic reactions (SARs) was defined according to the WAO SARs grading system.…”

B cells and food allergy

“…Other forms (e.g. epicutaneous and sublingual), are in development but none are known to be curative [66 ▪ ,77,78 ▪ ]. Thus, other therapeutic approaches for food allergy need to be evaluated.…”

“…Currently, treatment for most food allergies involves strict avoidance of the allergen and carriage of rescue medications, such as epinephrine and antihistamines, in the case of accidental exposure. OIT, including the recently Food and Drug Administration (FDA)-approved OIT for peanut, has been the most studied therapeutic approach and has been recently reviewed elsewhere [66 ▪ ,77,78 ▪ ]. Unfortunately, OIT has several limitations, including risk of allergic reactions to the therapy and lack of sustained benefit for most patients.…”