Israel: Cashew Oral Immunotherapy Study

In a new study published in the journal Allergy, it was found that cashew oral immunotherapy (OIT) desensitizes the majority of cashew-allergic patients and cross-desensitizes them to pistachio.

Oral immunotherapy is a therapeutic option for people who are allergic to milk, eggs, or peanuts, although research on the efficacy and safety of cashew OIT is lacking. As a result, Arnon Elizur and colleagues undertook this study to assess the efficacy of cashew OIT in reducing allergy symptoms.

A group of 50 cashew-allergic individuals aged 4 years or more were recruited in cashew OIT (target dosage 4000 mg protein) from 4/2016 to 12/2019. Fifteen cashew-allergic individuals who continued to avoid cashews acted as controls. It was discovered that the patient had a pistachio and walnut allergy. Both groups' full desensitization rates and accompanying immunological alterations were studied. Patients who had become completely desensitized to cashew were directed to ingest a dosage of 1200 mg cashew protein for 6 months before being exposed to the maximum amount. Patients with co-allergies to pistachio or walnut were exposed to the nut in question.

Results of the Study

• At the end of the research, 44 of 50 OIT-treated patients (88%) tolerated a dosage of 4000 mg cashew protein, compared to 0% of controls.
• 3 more patients were desensitized to 1200 mg cashew protein, and three patients discontinued therapy.
• For home responses, three patients (6%) received injectable epinephrine.
• Following therapy, desensitized individuals showed lower SPT, sIgE, basophil reactivity, and higher sIgG4.
• All pistachio (n = 35) and four of eight walnut co-allergic patients were cross-desensitized to the corresponding nut after cashew desensitization.
• Following desensitization, all (n = 44) patients who consumed a low cashew dosage for 6 months passed a full-dose cashew OFC.

In conclusion, the findings of this study point out the efficiency of OIT in desensitization of cashew allergy and it can also be followed safely with other food allergy OIT treatment.

Reference

Elizur, A, Appel, MY, Nachshon, L, et al. Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study). Allergy. 2022; 00: 1–10. doi:10.1111/all.15212