ii. Strengths and weaknesses
Although there are recent reviews on the management and diagnosis of
tree nut allergy5,6,37-39 this is the first systematic
review thoroughly investigating the available information on therapeutic
options for the desensitization of patients with IgE-mediated tree nut
allergy, other than peanut. Studies addressing the management of tree
nut allergy which did not fulfill the prespecified inclusion criteria of
this review can be found in Supplementary text.
Unfortunately, the heterogeneity of the studies included in this review
prevented pooling and meta-analysis (Supplementary Tables S2 and S3).
Only a small number of studies assessed interventions specifically for
tree nut allergy, while the majority referred to multi-food allergic
individuals, including subgroups with a co-existing tree nut allergy. To
overcome this, we had to extrapolate the participants and the outcomes
in interest, although they were not fully characterized. Caution should
also be taken when reviewing the numbers of patients treated with
multi-OIT, with or without omalizumab, as most studies are originated by
the same team, thus, the population might have specific demographic
characteristics or might have been recycled.