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.