Low-dose oral immunotherapy for walnut allergy with anaphylaxis: Three case reports

Sasamoto, Koki; Nagakura, Ken‐ichi; Sato, Sakura; Yanagida, Noriyuki; Ebisawa, Motohiro

doi:10.1016/j.alit.2021.01.007

Cited by 10 publications

(29 citation statements)

References 10 publications

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“…The results of a low-dose walnut-OIT in 3 children were recently reported by Sasamoto et al 37 . Children received an individualized home starting dose and gradually reached the maintenance dose of 75mg of walnut protein after 3, 4, and 3 months respectively.…”

Section: Single Tree Nutmentioning

confidence: 53%

“…1 and Table 1). Of them, five were randomized, double-blinded, placebo-controlled (RDBPC) studies [12][13][14][15][16] , one non-randomized, placebocontrolled 17 , eight prospective cohorts, including two conference abstracts [18][19][20][21][22][23][24][25] , five observational studies [26][27][28][29][30] , three retrospective studies [31][32][33] , one follow-up study 34 , and three case reports [35][36][37] .…”

Section: Resultsmentioning

confidence: 99%

“…In the case series of Sasamoto et al 37 , all children achieved two weeks SU to 450 mg after 24, 14, and 12 months on daily maintenance with 75 mg walnut.…”

Section: Sustained Unresponsivenessmentioning

confidence: 93%

See 2 more Smart Citations

Title: Current options in the management of tree nut allergy, focusing on, but not limited to immunotherapy: A systematic review.

Pasioti

Xepapadaki

Mathioudakis

et al. 2022

Preprint

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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.

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Section: Single Tree Nutmentioning

confidence: 53%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Title: Current options in the management of tree nut allergy, focusing on, but not limited to immunotherapy: A systematic review.

Pasioti

Xepapadaki

Mathioudakis

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Few reports describe OIT to other foods, including tree nut, sesame, cashew and wheat (111)(112)(113)(114)(115)(116)(117)(118)(119)(120)(121)(122) (Supplementary Table 1D). In the first reported walnut-OIT study (111), 73 patients were randomized in OIT (n = 55) group and control group (n = 18).…”

Section: Oit For Other Foodsmentioning

confidence: 99%

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

et al. 2022

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There is evidence that in children with persistent IgE-mediated food allergy (FA) to cow's milk, hen's egg, and peanut, oral allergen-specific immunotherapy (OIT) may increase the reaction threshold to the culprit food allergen(s). OIT may protect patients from the occurrence of severe reactions in case of accidental ingestion of the culprit food during treatment. Notwithstanding, many gaps are still unsolved, including safety issues, identification of predictive biomarkers, and post-desensitization efficacy. In this perspective, the use of omalizumab (Anti-IgE monoclonal antibody) has been proposed as an adjunctive treatment to OIT in order to reduce the risk of allergic reactions related to OIT. This review aims to summarize the current evidence and unmet needs on OIT in children with FA to enhance the development of longitudinal, prospective, and well-designed studies able to fill the current gaps soon.

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“…Increasing IgG4 to pistachio is seen following cashew-OIT, suggesting that cross-desensitization is achieved through desensitization of cashew-homologous components in pistachio [81]. Another recent case series from Japan showed the feasibility of low dose walnut OIT, which could be an option for patients with more severe phenotypes [82 ▪ ]. Conversely, peanut OIT does not appear to impact TN and sesame allergy [83].…”

Section: Novelties In Management Of Nut Allergymentioning

confidence: 99%

Recent advances in the diagnosis and management of tree nut and seed allergy

Labrosse

Graham

Caubet

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewTree nut (TN) and seed allergies are frequent, and their prevalence appears to be on the rise. Allergic reactions associated with these foods are more frequently severe, and these allergies tend to persist into adulthood, consequently affecting quality of life. In this review, we summarize recent advances in diagnostic modalities and management strategies for TN/seed-allergic patients.Recent findingsClinical manifestations of TN and seed allergy range from asymptomatic sensitization to severe anaphylactic reactions. The use of emerging diagnostic tools such as component resolved diagnostics (CRD) and the basophil activation test (BAT) can help better predict clinical reactivity, the latter being currently reserved for research settings. Strict avoidance of all TN is generally not required, as most patients can tolerate select TN despite co-sensitization. Oral immunotherapy (OIT) is a promising alternative treatment instead of complete avoidance of culprit allergens, as it can safely increase the allergy threshold.SummaryOur recent understanding of co-reactivity between various TN and seeds has shaped management opportunities, including select TN introduction and optimization of OIT, two strategies which may improve quality of life. There is a need for better minimally invasive diagnostic methods for TN and seed allergy, with CRD and BAT being promising tools.

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Low-dose oral immunotherapy for walnut allergy with anaphylaxis: Three case reports

Cited by 10 publications

References 10 publications

Title: Current options in the management of tree nut allergy, focusing on, but not limited to immunotherapy: A systematic review.

Title: Current options in the management of tree nut allergy, focusing on, but not limited to immunotherapy: A systematic review.

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

Recent advances in the diagnosis and management of tree nut and seed allergy

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