Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study)
Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study)
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DOI：
10.1111/all.15212
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发表时间：
2022-01-15
期刊：
影响因子：
12.4
通讯作者：
Goldberg, Michael R.
中科院分区：
文献类型：
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作者：
Elizur, Arnon;Appel, Michael Y.;Goldberg, Michael R.
背景口服免疫疗法（OIT）是牛奶、鸡蛋和花生过敏患者的一种治疗选择，但关于腰果OIT疗效和安全性的数据有限。方法一组50例年龄≥ 4岁的腰果过敏患者，在2016年4月至2019年12月期间连续入组腰果OIT（目标剂量4000 mg蛋白质）。15例持续消除腰果的腰果过敏患者作为观察对照。确定对开心果和核桃的共同过敏。比较两组完全脱敏率及相关免疫学变化。对腰果完全脱敏的患者被指示服用1200 mg腰果蛋白6个月，然后挑战全剂量。对阿月浑子或核桃共同过敏的患者被挑战各自的坚果。结果在研究结束时，50例OIT治疗患者中有44例（88%）耐受了4000 mg腰果蛋白，而对照组为0%（比值比8.3，95%CI 3.9-17.7，p < 0.001）。另外3名患者对1200 mg腰果蛋白脱敏，3名患者停止治疗。3例患者（6%）因家庭反应接受了肾上腺素注射治疗。治疗后，脱敏患者的SPT、sIgE、嗜碱性粒细胞反应性降低，sIgG 4升高。腰果脱敏后，所有的阿月浑子（n = 35）和四个8核桃共同过敏患者交叉脱敏各自的坚果。所有（n = 44）患者在脱敏后服用低剂量腰果≥ 6个月，均通过了全剂量腰果OFC。结论腰果OIT可使大多数腰果过敏患者脱敏，并对开心果交叉脱敏。安全性与其他食品的OIT相似。
Background Oral immunotherapy (OIT) is a treatment option for patients with milk, egg, and peanut allergy, but data on the efficacy and safety of cashew OIT are limited. Methods A cohort of 50 cashew-allergic patients aged >= 4 years, who were consecutively enrolled into cashew OIT (target dose 4000 mg protein) between 4/2016 and 12/2019. Fifteen cashew-allergic patients who continued cashew elimination served as observational controls. Co-allergy to pistachio and walnut was determined. Full desensitization rate and associated immunological changes in both groups were compared. Patients fully desensitized to cashew were instructed to consume a dose of 1200 mg cashew protein for 6 months and were then challenged to a full dose. Patients with co-allergy to pistachio or walnut were challenged to the respective nut. Results Forty-four of 50 OIT-treated patients (88%) compared to 0% in controls tolerated a dose of 4000 mg cashew protein at the end of the study (odds ratio 8.3, 95% CI 3.9-17.7, p < 0.001). An additional three patients were desensitized to 1200 mg cashew protein, and three patients stopped treatment. Three patients (6%) were treated with injectable epinephrine for home reactions. Desensitized patients had decreased SPT, sIgE, basophil reactivity, and increased sIgG4, following treatment. Following cashew desensitization, all pistachio (n = 35) and four of eight walnut co-allergic patients were cross-desensitized to the respective nut. All (n = 44) patients consuming a low cashew dose for >= 6 months following desensitization passed a full-dose cashew OFC. Conclusions Cashew OIT desensitizes most cashew-allergic patients and cross-desensitizes to pistachio. Safety is similar to OIT for other foods.