Michael B Levy, MD, Na’ama Epstein-Rigbi, MD, Bo Pontoppidan, PhD et al. Walnut oral immunotherapy for desensitisation of walnut and additional tree nut allergies (Nut CRACKER): a single-centre, prospective cohort studyĪrnon Elizur, MD, Michael Y Appel, PhD, Liat Nachshon, MD oral immunotherapy should be performed in centers that specializes in the diagnosis and treatment of food allergy. Response: This is the first large prospective study to demonstrate the effectiveness of oral immunotherapy to a single food in treating allergy to another un-treated food. : Is there anything else you would like to add? This will enable physicians to identify patients who are likely to benefit the most from single walnut oral immunotherapy. Response: The allergenic proteins that are shared by walnut and by additional tree nuts and those that are unique to each nut should be identified. : What recommendations do you have for future research as a result of this work? Response: Patients who are allergic to walnut and additional tree nuts can benefit from a single walnut oral immunotherapy with complete resolution of their allergies. : What should readers take away from your report? Although adverse reactions, including some requiring injectable epinephrine, occurred, the treatment was associated with a significant improvement in patient quality of life. Many patients who had several tree nut allergies were food allergy-free following walnut oral immunotherapy. This effect was seen primarily for hazelnut. 18/30 patients with additional allergies to hazelnut or cashew were able to eat, either freely or a limited amount of, hazelnut or cashew at the end of walnut OIT. 46 patients had additional pecan allergy and all were able to freely eat pecans at the end of walnut oral immunotherapy. Response: Walnut oral immunotherapy was administered to 55 walnut allergic patients and 89% of them were able to freely eat walnuts at the end of the treatment. However, limited data exists on oral immunotherapy for tree nuts and the treatment is complicated by the high prevalence of co-allergy to several nuts. ![]() In the past 10 years, oral immunotherapy (OIT) has shown promise as a treatment modality for milk, egg and peanut allergies. Patients with tree nut allergy are often allergic to several nuts, further increasing the risk of accidental exposures, dietary limitations, and the emotional burden and anxiety in affected patients. Response: Tree nuts are among the most common food allergies and are a major cause of fatal and near fatal reactions. Director, The Institute of Allergy, Immunology & Pediatric Pulmonology
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