iv. Implications for clinical practice
Although large studies are lacking, there are reports about implementing tree nut immunotherapy in clinical practice27,31,44-46. The effectiveness of lower doses (300mg protein) to maintain desensitization to higher doses, along with the cross-desensitization effect and the possibility of multi-OIT, can be translated into clinical practice with simultaneously desensitization to multiple nuts with properly designed oligo nut mixtures. Furthermore, a maintenance dose as low as 75 mg protein per day may confer protection from traces’ exposures, but this should be interpreted with caution, as only three cases are reported33.
Finally, tree nut allergic patients currently on biologics for other allergic comorbidities, might benefit from a re-evaluation, including OFCs, of the activity of their tree nut allergy.