Oral immunotherapy for hazelnut allergy

Published online: November 18, 2019

Hazelnut is one of the most common causes of food allergy in Europe. Oral immunotherapy (OIT) can protect patients with allergies to cow’s milk, egg and peanut from food-induced allergic reactions due to accidental exposure. However, OIT has not been extensively evaluated in hazelnut allergy.

In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, Moraly et al. reported a retrospective study evaluating the proportion of children successfully desensitized after 6 months of hazelnut OIT. The OIT protocol was tailored to the patient’s reactivity threshold, starting with 10% of the dose eliciting a hypersensitivity reaction during a placebo-controlled food challenge followed by a progressive escalation dose protocol. Every 6 months an open food challenge was performed, and a new escalation dose protocol initiated until desensitization, defined as the ability to tolerate a cumulative dose of 1635 mg hazelnut protein.

One hundred children were included (64% male, median age 5 years). At 6 months, the proportion of desensitized patients was 34% (95%CI: 25-44). Longer treatment was associated with a higher proportion of desensitized patients (44% at 12 months). Factors associated with successful desensitization were older age, smaller baseline skin prick test wheal diameter, lower hazelnut sIgE level and absence of cashew allergy. Adverse reactions occurred in 30% of patients, the most frequent being gastrointestinal symptoms including abdominal pain and nausea, and urticaria; none were severe. These results show for the first time that hazelnut OIT is associated with hazelnut desensitization and may be safe in the majority of patients.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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