Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study)
Elizur A, Appel MY, Nachshon L, Levy MB, Epstein-Rigbi N, Koren Y, Holmqvist M, Porsch H, Lidholm J, Goldberg MR
Allergy · 44 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (classified by our AI screen)
- Studied in
- People
- Main outcome
- Health markers and function
- Intake measured by
- Food provided by researchers
Who paid for it
- Funding
- Independent funding
- Government
- Ministry of Health, State of Israel
Based on 1 listed funder(s).
Publication
- Published
- 2022-01-09 · Allergy · vol. 77 · issue 6 · pp. 1863–1872
- Publisher
- Wiley
- Cited
- 56 citations · more than 98% of similar papers · 6.6× the field average
- Impact
- Top 10% most cited in its field
- References
- 41 works
- Access
- Paywalled
- Research areas
- Food Allergy and Anaphylaxis Research · Respiratory and Cough-Related Research · Oral Health Pathology and Treatment
- Keywords
- Oral immunotherapy, Allergy, Immunotherapy, Immunopathology, Respiratory Hypersensitivity
- MeSH
- humans, anacardium, pistacia, nut hypersensitivity, immunotherapy, desensitization, immunologic, administration, oral, child, preschool
10 authors
From IL, SE
- Arnon Elizur · correspondingTel Aviv University; Assaf Harofeh Medical Center
- Michael Y. AppelAssaf Harofeh Medical Center
- Liat NachshonTel Aviv University; Assaf Harofeh Medical Center
- Michael B. LevyAssaf Harofeh Medical Center
- Naama Epstein‐RigbiTel Aviv University; Assaf Harofeh Medical Center
- Yael KorenAssaf Harofeh Medical Center
Abstract
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.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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