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Cashew is Healthy for the Entire Family

Cashew Oral Immunotherapy for Desensitizing

Cashew-Pistachio Allergy (Nut Cracker Study)

Author(s): Arnon Elizur, Michael Y. Appel, Liat Nachshon, Michael B. Results: Forty-four of 50
Levy, Naama Epstein-Rigbi, Yael Koren, Marie Holmqvist, Helena Porsch, OIT-treated patients (88%) com-
Jonas Lidholm, Michael R. Goldberg pared to 0% in controls tolerat-
First published: 09 January 2022 ed a dose of 4000 mg cashew
protein at the end of the study
(odds ratio 8.3, 95% CI 3.9–17.7,
Abstract p < 0.001). An additional three
Background
patients were desensitized to
Oral immunotherapy (OIT) is a treatment option for patients with milk, egg, 1200 mg cashew protein, and
and peanut allergy, but data on the efficacy and safety of cashew OIT are
three patients stopped treatment.
limited.
Three patients (6%) were treated
with injectable epinephrine for
Methods home reactions. Desensitized pa-
A cohort of 50 cashew-allergic patients aged ≥4 years, who were consec-
tients had decreased SPT, sIgE,
utively enrolled into cashew OIT (target dose 4000 mg protein) between basophil reactivity, and increased
4/2016 and 12/2019. Fifteen cashew-allergic patients who continued cashew
sIgG4, following treatment.
elimination served as observational controls. Co-allergy to pistachio and wal- Following cashew desensitization,
nut was determined. Full desensitization rate and associated immunological
all pistachio (n = 35) and four of
changes in both groups were compared. Patients fully desensitized to cashew eight walnut co-allergic patients
were instructed to consume a dose of 1200 mg cashew protein for 6 months
were cross-desensitized to the re-
and were then challenged to a full dose. Patients with co-allergy to pistachio spective nut. All (n = 44) patients
or walnut were challenged to the respective nut.
consuming a low cashew dose
for ≥6 months following desensiti-
zation passed a full-dose cashew
OFC.

Conclusion
Cashew OIT desensitizes most
cashew-allergic patients and cross-de-
sensitizes to pistachio. Safety is similar
to OIT for other foods.

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