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Current options in the management of tree nut allergy. A systematic review and narrative synthesis.
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  • Maria Pasioti,
  • Paraskevi Xepapadaki,
  • Alexander G. Mathioudakis,
  • John Lakoumentas,
  • Elvira Efstathiou,
  • Nikos Papadopoulos
Maria Pasioti
National and Kapodistrian University of Athens

Corresponding Author:[email protected]

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Paraskevi Xepapadaki
National and Kapodistrian University of Athens
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Alexander G. Mathioudakis
The University of Manchester Division of Infection Immunity and Respiratory Medicine
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John Lakoumentas
National and Kapodistrian University of Athens
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Elvira Efstathiou
National and Kapodistrian University of Athens
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Nikos Papadopoulos
National and Kapodistrian University of Athens
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Abstract

Background: Tree nut allergy is usually life-long and potentially life-threatening. Standard of care consists of strict avoidance of the culprit nut and symptomatic treatment of accidental reactions. Objective: To evaluate the potential therapeutic options for desensitization of patients with IgE-mediated tree nut allergy, focusing on, but not limited to, immunotherapy. Methods: We systematically searched three bibliographic databases for studies published until July 2022 for active treatments of IgE-mediated allergy to tree nuts (walnut, hazelnut, pistachio, cashew, and almond) with allergen-specific immunotherapy (AIT) using oral (OIT), sublingual (SLIT), epicutaneous (EPIT) or subcutaneous (SCIT) delivery, or with other disease-modifying treatments. Results: We included 17 studies (three randomized, double-blinded, placebo-controlled, five quasi-experimental prospective cohorts, five prospective cohorts, two retrospective cohorts, and two case reports. Three studies investigated sublingual immunotherapy, five investigated oral immunotherapy to a single tree nut, and six used multi-food oral immunotherapy with (four) or without (two) omalizumab. The remaining studies investigated the effectiveness of monoclonal antibodies in multi-food allergic patients, including patients with a tree nut allergy. The heterogeneity of the studies prevented pooling and meta-analysis. Conclusion: Even though strict avoidance remains the standard of care for patients with tree nut allergy, alternative approaches have been tested in clinical trials and real-life studies. These new concepts require further investigation with more well-designed studies including well-characterized nut allergic patients before implementing them in daily clinical practice.
04 Oct 2023Submitted to Pediatric Allergy and Immunology
04 Oct 2023Submission Checks Completed
04 Oct 2023Assigned to Editor
04 Oct 2023Review(s) Completed, Editorial Evaluation Pending
18 Oct 2023Reviewer(s) Assigned
15 Mar 20241st Revision Received
20 Mar 2024Submission Checks Completed
20 Mar 2024Assigned to Editor
20 Mar 2024Review(s) Completed, Editorial Evaluation Pending
21 Mar 2024Reviewer(s) Assigned
10 Apr 2024Editorial Decision: Accept