Oral Immunotherapy for cashew nut and peanut allergy in children -- a retrospective single-center study

Background Oral immunotherapy (OIT) is increasingly used for the treatment of childhood food allergies, with limited data available on cashew nut allergy OIT. This study investigated the safety and feasibility of cashew nut OIT, comparing it with peanut OIT. Methods We retrospectively analyzed cashew nut (n=24) and peanut (n=38) OIT cases initiated between 2018 and 2022. Two different starting protocols were used, and nut intake was then incrementally increased by 20-30% every two weeks to reach a maintenance dose of 1 g of nut protein. After consuming the maintenance dose regularly for 18-24 months, a second oral food challenge was performed. Patients who passed this challenge were considered desensitized. The safety of the therapy was evaluated based on the frequency and severity of adverse reactions during the up-dosing phase. Results Over the study period, 33% of cashew nut-allergic and 63% of peanut-allergic patients experienced mild to moderate side effects. Severe reactions occurred in five peanut-allergic children with high initial IgE levels. Six patients with peanut and none with cashew nut OIT, were discontinued due to side effects. The mean duration to reach the maintenance phase was longer for children with asthma or another food allergy. Among children undergoing the second challenge, desensitization was achieved in 88% of cashew nut and 69% of peanut-allergic patients. Conclusion Cashew nut OIT had a low frequency of adverse effects and was generally well tolerated. However, patient characteristics influenced side effect risk and treatment duration, emphasizing the need for individualized OIT plans.