02 Apr Walnut Oral Immunotherapy Is Effective For the Treatment of Walnut as well as Additional Tree Nut Allergies

MedicalResearch.com Interview with:

Dr. Elizur

Arnon Elizur MD
Director, The Institute of Allergy, Immunology & Pediatric Pulmonology
Yitzhak Shamir Medical Center
Zerifin, Israel

MedicalResearch.com: What is the background for this study?  

Response: Tree nuts are among the most common food allergies and are a major cause of fatal and near fatal reactions. 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.

In the past 10 years, oral immunotherapy (OIT) has shown promise as a treatment modality for milk, egg and peanut allergies. 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.

MedicalResearch.com: What are the main findings? 

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. 46 patients had additional pecan allergy and all were able to freely eat pecans at the end of walnut oral immunotherapy. 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. This effect was seen primarily for hazelnut. Many patients who had several tree nut allergies were food allergy-free following walnut oral immunotherapy. Although adverse reactions, including some requiring injectable epinephrine, occurred, the treatment was associated with a significant improvement in patient quality of life.

MedicalResearch.com: What should readers take away from your report?

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. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

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. This will enable physicians to identify patients who are likely to benefit the most from single walnut oral immunotherapy. 

MedicalResearch.com: Is there anything else you would like to add?

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. oral immunotherapy should be performed in centers that specializes in the diagnosis and treatment of food allergy. 

Citation:

Walnut oral immunotherapy for desensitisation of walnut and additional tree nut allergies (Nut CRACKER): a single-centre, prospective cohort study
Arnon Elizur, MD , Michael Y Appel, PhD, Liat Nachshon, MD
Michael B Levy, MD, Na’ama Epstein-Rigbi, MD, Bo Pontoppidan, PhD et al.

Published:March 26, 2019

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Last Updated on April 2, 2019 by Marie Benz MD FAAD