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The authors declare no conflicts of interest.
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No external funding.
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Abstract:
Background
Oral immunotherapy (OIT) is increasingly used for the treatment of
childhood food allergies, with limited data available on cashew nut
allergy OIT. This study investigated the safety and feasibility of
cashew nut OIT, comparing it with peanut OIT.
Methods
We retrospectively analyzed cashew nut (n=24) and peanut (n=38) OIT
cases initiated between 2018 and 2022. Two different starting protocols
were used, and nut intake was then incrementally increased by 20-30%
every two weeks to reach a maintenance dose of 1 g of nut protein. After
consuming the maintenance dose regularly for 18-24 months, a second oral
food challenge was performed. Patients who passed this challenge were
considered desensitized. The safety of the therapy was evaluated based
on the frequency and severity of adverse reactions during the up-dosing
phase.
Results
Over the study period, 33% of cashew nut-allergic and 63% of
peanut-allergic patients experienced mild to moderate side effects.
Severe reactions occurred in five peanut-allergic children with high
initial IgE levels. Six patients with peanut and none with cashew nut
OIT, were discontinued due to side effects. The mean duration to reach
the maintenance phase was longer for children with asthma or another
food allergy. Among children undergoing the second challenge,
desensitization was achieved in 88% of cashew nut and 69% of
peanut-allergic patients.
Conclusion
Cashew nut OIT had a low frequency of adverse effects and was generally
well tolerated. However, patient characteristics influenced side effect
risk and treatment duration, emphasizing the need for individualized OIT
plans.
Key words:
Cashew nut allergy, peanut allergy, tree nut allergy, food allergy, oral
immunotherapy, OIT, desensitization
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