Real-life experience with hazelnut oral immunotherapy

Sabouraud, M.; Bierme, P.; André-Gomez, S A; Villard-Truc, F.; Payot, F.; Correard, A.K.; Garnier, L.; Braun, C.

doi:10.1016/j.anai.2022.01.002

Cited by 12 publications

(35 citation statements)

References 20 publications

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“…Sabouraud et al [ 93 ] presented retrospective results on 70 patients (median age 10 years) treated with hazelnut OIT. Daily doses of cooked hazelnut were administered starting from 10% of their individualized target dose, and then progressively increased over the course of six months.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Natural History of Hazelnut Allergy and Current Approach to Its Diagnosis and Treatment

et al. 2023

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Hazelnut allergy is the most prevalent type of nut allergy in Europe, with symptoms that can range from mild, such as hives and itching, to severe, such as anaphylaxis, particularly in patients who are sensitized to highly stable allergens, such as storage proteins. Compared to other types of food allergies, allergies to tree nuts, including hazelnuts, tend to persist throughout life. Although symptoms can appear in early childhood, they often continue into adulthood, with a minority of cases improving during adolescence. Currently, there is no curative treatment available for hazelnut allergy, and patients must adhere to a restrictive diet and carry autoinjective epinephrine. However, oral allergen immunotherapy (AIT) is a promising treatment option. Patients can be categorized based on their risk for severe reactions using various clinical, in vivo, and in vitro tests, including component-resolved diagnosis and oral food challenge. This review aims to provide an overview of the current knowledge of the natural history of hazelnut allergy and new approaches for its diagnosis and management.

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Section: Prevention and Treatmentmentioning

confidence: 99%

Natural History of Hazelnut Allergy and Current Approach to Its Diagnosis and Treatment

et al. 2023

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“…Moraly et al [77] were the first to describe the successful desensitization of 100 hazelnut-allergic patients using OIT, with no serious side-effects reported. Recently, Sabouraud et al [76 ▪ ] reported on the real-life experience of 70 children undergoing hazelnut OIT using a tailored approach for each patient. Sixty percentage (60%) reached the maintenance dose during the study period, with a median cumulative ingested dose 10-fold greater than at baseline.…”

Section: Novelties In Management Of Nut Allergymentioning

confidence: 99%

“…The routes of food immunotherapy include epicutaneous (EPIT), sublingual (SLIT), and oral (OIT), of which the latter has been the most studied. Although a commercially available product for OIT has only been approved for peanut to date [73], recent studies have reported the feasibility, efficacy and safety of TN and sesame OIT (Table 2) [74,75,76 ▪ ,77,78]. Moraly et al [77] were the first to describe the successful desensitization of 100 hazelnut-allergic patients using OIT, with no serious side-effects reported.…”

Section: Novelties In Management Of Nut Allergymentioning

confidence: 99%

Recent advances in the diagnosis and management of tree nut and seed allergy

Labrosse

Graham

Caubet

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewTree nut (TN) and seed allergies are frequent, and their prevalence appears to be on the rise. Allergic reactions associated with these foods are more frequently severe, and these allergies tend to persist into adulthood, consequently affecting quality of life. In this review, we summarize recent advances in diagnostic modalities and management strategies for TN/seed-allergic patients.Recent findingsClinical manifestations of TN and seed allergy range from asymptomatic sensitization to severe anaphylactic reactions. The use of emerging diagnostic tools such as component resolved diagnostics (CRD) and the basophil activation test (BAT) can help better predict clinical reactivity, the latter being currently reserved for research settings. Strict avoidance of all TN is generally not required, as most patients can tolerate select TN despite co-sensitization. Oral immunotherapy (OIT) is a promising alternative treatment instead of complete avoidance of culprit allergens, as it can safely increase the allergy threshold.SummaryOur recent understanding of co-reactivity between various TN and seeds has shaped management opportunities, including select TN introduction and optimization of OIT, two strategies which may improve quality of life. There is a need for better minimally invasive diagnostic methods for TN and seed allergy, with CRD and BAT being promising tools.

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“…Furthermore, this food allergy is generally persistent [15], and the presence of a high degree of cross-reactivity of hazelnut allergens with those of other nuts further complicates its management [16]. Promising new management strategies currently under study in children with hazelnut allergy are the selection of hypoallergenic cultivars and the development of oral desensitization protocols (OIT) [16,17].…”

Section: Introductionmentioning

confidence: 99%

The Severity and Frequency of Systemic Reactions to Hazelnut Are Significantly Higher in Hazelnut Allergic Patients Monosensitized to Cor a 8 than in Patients Polysensitized to Cor a 1, Cor a 8, and Cor a 9

Pastorello,

Scibilia,

Rossi

et al. 2023

Int Arch Allergy Immunol

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Introduction: Hazelnuts are a leading trigger of food allergy. To date, several molecular components of hazelnut are available for component-resolved diagnosis. However, little is known about how simultaneous sensitization to multiple allergens affects the severity of the hazelnut-induced reaction. In a previous study, our group demonstrated a lower risk of systemic reactions to peach in patients sensitized to both Pru p 3 and Pru p 1 than in the patient monosensitized to peach LTP. We aimed to assess whether this was also true in hazelnut allergy in a cohort of adult patients. Methods: Patients were selected based on a history of symptoms such as urticaria, vomiting, diarrhea, asthma, and anaphylaxis indicative of hazelnut IgE-mediated food allergy and graded according to a clinical severity scale. For all patients, specific IgE was determined for Cor a 1 and Cor a 8 and, for most patients, also Cor a 9. Patients were offered an oral food challenge in open format (OFC) with a cocoa-based roasted hazelnut spread on a voluntary basis in order to prescribe an appropriate diet. Results: A total of two hundred and fourteen patients were recruited. Among these, 43 patients were monosensitized to Cor a 8. One hundred and seventy-one patients were sensitized to Cor a 1 (79.9%), and, among them, 48/171 (28.1%) were also Cor a 8 positive. Cor a 9 was evaluated in 124/214 patients, testing positive in 21/124 (16.9%). Patients monosensitized to Cor a 8 experienced systemic reactions more frequently than those sensitized to Cor a 1 ± Cor a 8 (p < 0.00001), with significantly more severe reactions (p < 0.0005) and testing more frequently positive at OFC (p < 0.0001). Regarding Cor a 9, the sensitized patients were significantly younger (p = 0.0013) and showed reactions of similar severity to patients who tested Cor a 9 negative, and these reactions were milder than in patients monosensitized only to Cor a 8. Discussion/Conclusion: Sensitization to Cor a 1 seems to protect from the development of the severe systemic reactions induced by Cor a 8 sensitization, Cor a 9 does not influence the severity of symptoms in adult patients. The OFC with roasted hazelnut may help in dietary guidance.

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Real-life experience with hazelnut oral immunotherapy

Cited by 12 publications

References 20 publications

Natural History of Hazelnut Allergy and Current Approach to Its Diagnosis and Treatment

Natural History of Hazelnut Allergy and Current Approach to Its Diagnosis and Treatment

Recent advances in the diagnosis and management of tree nut and seed allergy

The Severity and Frequency of Systemic Reactions to Hazelnut Are Significantly Higher in Hazelnut Allergic Patients Monosensitized to <i>Cor a 8</i> than in Patients Polysensitized to <i>Cor a 1</i>, <i>Cor a 8</i>, and <i>Cor a 9</i>

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