OIT protocol
Two different strategies were used to start the OIT (see Supplementary table 1). All 24 patients with CN allergy and 20 out of 38 patients (52%) with peanut allergy, initiated OIT with an open OFC. The OFC protocol, following international guidelines, was stopped when symptoms appeared, in line with the PRACTALL consensus report20. The dosage at symptoms onset was considered the individual reactive dose. For these patients, OIT began with the highest tolerated OFC dose. 18 high-risk peanut patients started with an initial dose escalation, gradually increasing doses to 0.0064 g of nut protein as the OIT starting dose (Supplementary table 1).
Patients increased their nut intake by 20-30% every two weeks, targeting a 1 g nut protein maintenance dose. Increases were avoided during pollen season to reduce side effects in patients with seasonal symptoms, or when reactions occurred.
After reaching the maintenance dose of 1 g nut protein, patients continued this regimen for four weeks daily and then every other day for 18-24 months. One patient in the CN group and two in the peanut group bypassed the up-dosing phase as they tolerated the maintenance dose directly during the initial OFC. Following the maintenance period, another OFC was conducted. Those who consumed a total of 4.4 g of nut protein were considered desensitized, allowed to freely consume the nut but advised to intake at least 1g of nut protein twice a week. In case of intolerance during this second OFC, patients returned to their previous maintenance regimen.