Hazelnut oral immunotherapy desensitizes hazelnut but not other tree nut allergies (Nut CRACKER Study).

IF 8.2 1区医学 Q1 ALLERGY Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-01-10 DOI:10.1016/j.jaip.2024.12.041

Arnon Elizur, Yael Koren, Michael Y Appel, Liat Nachshon, Michael B Levy, Naama Epstein-Rigbi, Lars Mattsson, Marie Holmqvist, Jonas Lidholm, Michael R Goldberg

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Abstract

Background: Data on oral immunotherapy (OIT) for hazelnut allergy is limited and its potential to cross-desensitize for other nuts is unknown.

Objective: To study the efficacy and safety of hazelnut OIT in desensitizing hazelnut and additional tree nuts.

Methods: A prospective observational study of 30 hazelnut allergic patients aged ≥4 years who underwent hazelnut OIT. Full desensitization (4000 mg protein) rates were compared to 14 observational controls, and immunological changes during OIT were measured. Cross-desensitization was determined in cases of walnut and cashew co-allergy (n=12). Inhibition of IgE binding to walnut by hazelnut was evaluated in a separate set of walnut-hazelnut dual allergic patients, by ELISA.

Results: The rate of full hazelnut desensitization following OIT was 96.7% (29/30) compared to 14.3% (2/14) in controls (OR=25.7, 95% CI 3.7-178.7, p<0.001). Five patients (16.7%) were treated with injectable epinephrine for home reactions. Hazelnut SPT and sIgE to hazelnut and its main components, Cor a 9, 14 and 16, decreased while sIgG4 increased during OIT. A maintenance dose of 1200 mg hazelnut protein was sufficient to maintain full desensitization. No cross-desensitization was noted in dual hazelnut-cashew allergic patients (n=6). In dual hazelnut-walnut allergic patients, an increase in the walnut eliciting dose was observed in 2/6 (33.2%) patients (to 1200 and 4200 mg, respectively). Similarly, by cross-inhibition ELISA, hazelnut competed for IgE-binding to walnut in 5/25 (20%) hazelnut-walnut co-allergic patients.

Conclusions: Hazelnut OIT is highly effective, with a similar safety profile as OIT to other nuts. Cross-desensitization to walnut and cashew is unlikely.

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背景：有关榛子过敏的口服免疫疗法（OIT）数据有限，而且其对其他坚果交叉致敏的可能性尚不清楚：有关口服免疫疗法（OIT）治疗榛子过敏的数据很有限，而且这种疗法对其他坚果的交叉脱敏潜力尚不清楚：研究榛子口服免疫疗法对榛子和其他树坚果脱敏的有效性和安全性：前瞻性观察研究：30 名年龄≥4 岁的榛子过敏患者接受了榛子 OIT。将完全脱敏率（4000 毫克蛋白质）与 14 个观察对照组进行比较，并测量 OIT 期间的免疫学变化。对核桃和腰果共同过敏的病例（12 人）进行了交叉脱敏测定。在另一组核桃-榛子双重过敏患者中，通过 ELISA 评估了榛子对核桃 IgE 结合的抑制作用：结果：OIT 后榛子完全脱敏率为 96.7%（29/30），而对照组为 14.3%（2/14）（OR=25.7，95% CI 3.7-178.7，p 结论：榛子 OIT 非常有效，其安全性与其他坚果的 OIT 相似。对核桃和腰果交叉脱敏的可能性不大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.