iv. Implications for clinical practice
Although large studies are lacking, there are reports about implementing
tree nut immunotherapy in clinical
practice27,31,44-46. The effectiveness of lower doses
(300mg protein) to maintain desensitization to higher doses, along with
the cross-desensitization effect and the possibility of multi-OIT, can
be translated into clinical practice with simultaneously desensitization
to multiple nuts with properly designed oligo nut mixtures. Furthermore,
a maintenance dose as low as 75 mg protein per day may confer protection
from traces’ exposures, but this should be interpreted with caution, as
only three cases are reported33.
Finally, tree nut allergic patients currently on biologics for other
allergic comorbidities, might benefit from a re-evaluation, including
OFCs, of the activity of their tree nut allergy.