Introduction
Cashew nuts (CN) are a common cause of food allergies worldwide1–3 , often triggering more severe reactions than
other foods4 5. The prevalence of CN
allergies is on the rise6, possibly due its increasing
use in the Western World’s diet. In Europe, peanuts are the primary
cause of anaphylaxis in children under 18 years old, with CN ranking
first in Switzerland7,8. Even a small amount (less
than one teaspoon) of CN or peanut can induce an allergic
reaction8. Notably, in only about 9% of all tree nut
allergies and 29% of peanut allergies natural tolerance
occurs9 10. Therefore, it is
imperative to explore strategies to enhance reaction threshold and
minimize the risk of severe reactions11.
In recent years, oral immunotherapy (OIT) has emerged as a promising
therapeutic option for children with food allergies supported by
encouraging data12–15. In 2018, the European Academy
of Allergy and Clinical Immunology (EAACI) officially recommended
allergen immunotherapy for peanut, milk and egg allergies in children
above 4 years old with persistent Immunoglobulin E (IgE)-mediated food
allergies16. However, several studies have shown that
OIT increases the likelihood of allergic reactions, mostly mild in
nature, but severe reactions are possible 1217. While OIT for tree nuts lacks official
endorsement, it is frequently employed, yet data on its efficacy and
safety remain scarce. The NUT CRACKER (Nut Co-Reactivity—Acquiring
Knowledge for Elimination Recommendations) study, a prospective cohort
study involving 50 patients undergoing CN OIT, showed promising results
with a high rate of desensitization and moderate incidence of adverse
reactions18. Another real-life analysis of preschool
children who underwent OIT for tree nuts, including CN, demonstrated a
moderate rate of side effects (70.7%)19.
This retrospective single-center study aimed to evaluate the safety and
feasibility of CN OIT, comparing it with peanut OIT. We also aimed to
identify factors influencing side effects and treatment duration.