Tree nut oral immunotherapy both safe and tolerable among Preschoolers

The researchers of the present study mentioned that their group previously described preschool peanut oral immunotherapy (OIT) in a real-world, multicenter setting for preschoolers. The study results suggested that the therapy is safe.

This study examined whether tree nut (TN) immunotherapy is safe and tolerable in preschoolers.

TN-OIT (cashew/pistachio, walnut/pecan, hazelnut, almond, and macadamia nut) was performed in preschoolers. These had skin prick test wheal diameter ≥ 3 mm or a specific IgE level ≥ 0.35 kU/L and a convincing objective IgE-mediated reaction; there was no history of ingestion with a particular level of Ige≥5 kU/L.

Dose escalations were performed every 2 to 4 weeks till a maintenance dose of 300 mg of TN protein was reached. The modified World Allergy Organization Subcutaneous Immunotherapy Reaction Grading System recorded from 1 as mildest and five as fatal was used for recording and classifying symptoms.

The study results could be summarised as follows:

• There were 92 patients starting tree nut oral immunotherapy TN-OIT ( 2018 – 2021).
• Seventy-nine patients underwent single-food TN-OIT, and 13 underwent multifood TN-OIT to 2 or 3 tree nuts.
• Maintenance was reached by Eighty-nine patients constituting 96.7%.
• Four patients constituting 4.3%, dropped out.
• Sixty-five constituting 70.7% of patients, experienced reactions during buildup with grade 1 reactions (35 patients), grade 2 reactions (30 patients), no grade 3 or 4 reactions, and 2 received epinephrine.

Further concluding, they wrote that “We find the results of the present study comparable to our previous study on peanut oral immunotherapy.”

Our study’s findings prove the safety and tolerability of TN-OIN in Preschool.

Further reading:

Real-World Safety Analysis of Preschool Tree Nut Oral Immunotherapy. https://doi.org/10.1016/j.jaip.2023.01.031