Validation of the NUT CRACKER Diagnostic Algorithm and Prediction for Cashew and Pistachio Co-Allergy.

Background: Because of the high cross-sensitization among tree nuts, the NUT CRACKER (Nut Co-reactivity-Acquiring Knowledge for Elimination Recommendations) study proposed a diagnostic algorithm to minimize the number of required oral food challenges (OFCs).

Objective: To validate the algorithm for cashew and pistachio allergy and determine markers for allergic severity.

Methods: Patients (n = 125) with a median age of 7.

Sesame eliciting and safe doses in a large sesame allergic population.

Background: Sesame is a significant food allergen causing severe and even fatal reactions. Given its increasing prevalence in western diet, sesame is listed as an allergenic food requiring labeling in the United States and EU. However, data on the population reaction doses to sesame are limited.

Severe Anaphylactic Reactions to Home Doses of Oral Immunotherapy for Food Allergy.

Background: Severe anaphylactic reactions to home doses may occur during food allergy oral immunotherapy (OIT).

Objective: To study the rate and risk factors for such reactions.

Methods: We studied all patients aged greater than 3.

Factors associated with home epinephrine-treated reactions during peanut and tree-nut oral immunotherapy.

Background: Home reactions requiring epinephrine administration, a marker of their severity, restrict the widespread use of oral immunotherapy (OIT), but their risk factors are largely not known.

Objective: To identify risk factors for such reactions during OIT to most allergenic foods.

Methods: All patients who began OIT for peanut, tree nuts, sesame, or egg allergy at the Shamir Medical Center between April 2010 and January 2020 were enrolled.

Efficacy and safety of food allergy oral immunotherapy in adults.

Background: Oral immunotherapy (OIT) is an emerging method for treating food allergy in children. However, data regarding adults undergoing this process are lacking.

Methods: We retrospectively analyzed the medical records of patients with food allergy aged ≥17 years who completed OIT treatment between April 2010 and December 2020 at Shamir Medical Center.

Characteristics of patients diagnosed as non-allergic following food allergy oral immunotherapy referral.

Background: Ascribing food allergy diagnosis to patients who are not allergic is well described, but its implications on oral immunotherapy (OIT) have not been studied. The aim was to study non-allergic patients referred for OIT.

Methods: All patients who began OIT at Shamir Medical Center between November 2015 and August 2020 were included.

Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study).

Background: Oral immunotherapy (OIT) is a treatment option for patients with milk, egg, and peanut allergy, but data on the efficacy and safety of cashew OIT are limited.

Methods: A cohort of 50 cashew-allergic patients aged ≥4 years, who were consecutively enrolled into cashew OIT (target dose 4000 mg protein) between 4/2016 and 12/2019. Fifteen cashew-allergic patients who continued cashew elimination served as observational controls.

Triggers for Home Epinephrine-Treated Reactions During Oral Immunotherapy for Food Allergy.

Background: Home reactions requiring epinephrine treatment represent a significant obstacle to oral immunotherapy (OIT) and impair treatment outcome.

Objective: To identify potential triggers for such reactions for improvement of patient safety.

Methods: All patients aged older than 3.

Home epinephrine-treated reactions in food allergy oral immunotherapy: Lessons from the coronavirus disease 2019 lockdown.

Background: Oral immunotherapy (OIT) is effective in desensitizing patients with food allergy but adverse reactions limit its use.

Objective: To study the effect of the coronavirus disease 2019 lockdown in Israel between March 15, 2020, and April 30, 2020, on the incidence of home epinephrine-treated reactions.

Methods: All patients who were in the up-dosing phase of OIT for greater than or equal to 1 month during the lockdown, or a respective period in years 2015 to 2019, were studied.

Combinatorial advantage of Ses i 1-specific IgE and basophil activation for diagnosis of sesame food allergy.

Background: The prevalence of sesame food allergy (SFA) is increasing worldwide with the potential of anaphylactic reactions upon exposure. Utility of specific component IgE testing as an alternative to the oral food challenge (OFC), the diagnostic standard, is being investigated.

Methods: Patients (n = 42) with suspected SFA completed an open OFC to sesame.

Medical clown support is associated with better quality of life of children with food allergy starting oral immunotherapy.

Background: The start of oral immunotherapy (OIT) for food allergy is a critical period in the treatment process, with a potential to influence patient quality of life (QOL) and subsequently treatment outcome. The association of medical clowning with QOL at OIT initiation was examined.

Methods: Children aged 4-12 years supported by a medical clown (MC) during the induction week of OIT for food allergy were studied.

Subjective oral symptoms are insufficient predictors of a positive oral food challenge.

Background: Subjective oral symptoms, especially if recurrent, might lead to termination of an oral food challenge (OFC) for fear of a subsequent severe reaction.

Methods: In a single-center retrospective cohort study, oral food challenges to milk, egg, peanut, sesame, or tree nuts performed between January 2016 and January 2018 in patients aged ≥3 years, at the Institute of Allergy, Immunology and Pediatric Pulmonology in Shamir Medical Center, were analyzed. Subjective oral symptoms during the challenge were documented, and their association with the challenge outcome was examined.

A Prospective Validation of the NUT CRACKER Diagnostic Algorithm for Walnut and Pecan Allergy with Prediction of Severity.

Background: We previously devised an algorithm using skin prick tests (SPT), basophil activation tests (BAT), and co-allergy status to reduce the need for oral food challenges (OFCs) in 63 patients with suspected walnut/pecan allergies.

Objective: To validate prospectively the NUT CRACKER (Nut Co-Reactivity-Acquiring Knowledge for Elimination Recommendations) diagnostic algorithm in a new cohort of patients (n = 120) and to study the utility of SPT and BAT in predicting walnut-pecan allergy severity in both groups (n = 183).

Methods: Patients (n = 183) aged 8 (6-11) years, median (interquartile range), with suspected tree nut allergy were studied.

Patient Characteristics and Risk Factors for Home Epinephrine-Treated Reactions During Oral Immunotherapy for Food Allergy.

Background: Oral immunotherapy (OIT) is effective in desensitizing food-allergic patients but adverse events limit its applicability.

Objective: To identify risk factors for home epinephrine-treated reactions during the build-up phase of OIT.

Methods: A retrospective cohort study of patients older than 3.

Quality of life of children aged 8-12 years undergoing food allergy oral immunotherapy: Child and parent perspective.

Background: Oral immunotherapy (OIT) for food allergy improves the quality of life (QOL) of children from parental perspective but little is known about the child perception.

Methods: The Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF) was administered to children aged 8-12 years, and the FAQLQ-Parent Form (FAQLQ-PF) was administered to their parents at the start of OIT for milk, egg, peanut, sesame, or tree nuts, at the end of up-dosing, and after 6 months of follow-up. Food-allergic children not undergoing OIT served as controls.

Clinical and Molecular Characterization of Walnut and Pecan Allergy (NUT CRACKER Study).

Background: Diagnostic methods for distinguishing walnut-allergic patients from walnut-sensitized but walnut-tolerant individuals are limited. Furthermore, characteristics of single walnut versus dual walnut-pecan allergy are lacking.

Objective: To provide clinical and molecular characteristics of walnut- and pecan-allergic patients.

Risk Factors and Treatment Outcomes for Oral Immunotherapy-Induced Gastrointestinal Symptoms and Eosinophilic Responses (OITIGER).

Background: We recently described that oral immunotherapy (OIT)-induced gastrointestinal symptoms were associated with peripheral eosinophilic responses (termed OITIGER).

Objective: To identify treatment outcomes after dose modification and risk factors for developing OITIGER.

Methods: Treatment modifications in patients with OITIGER (n = 65) including cumulative dose reductions or treatment suspension were individualized and based on the severity of symptoms and an associated absolute eosinophil count (AEC, eosinophils/μL) of more than 900.

Efficacy and Safety of Sesame Oral Immunotherapy-A Real-World, Single-Center Study.

Background: The presence of sesame in Western diet is increasing, making its avoidance by sesame-allergic patients more challenging.

Objective: To report the efficacy and safety of sesame oral immunotherapy (OIT).

Methods: Sixty patients aged 4 years or older, diagnosed as sesame-allergic on the basis of a positive oral food challenge, were consecutively enrolled into OIT between November 2014 and November 2017.

Walnut oral immunotherapy for desensitisation of walnut and additional tree nut allergies (Nut CRACKER): a single-centre, prospective cohort study.

Background: The safety and efficacy of oral immunotherapy for tree nut allergy has not been demonstrated to date, and its effectiveness is complicated by the high prevalence of co-allergies to several nuts. This study aimed to investigate the use of walnut oral immunotherapy in the desensitisation of walnut and additional tree nuts in patients who are co-allergic to several nuts.

Methods: In a single-centre, prospective cohort study (the Nut Co-Reactivity ACquiring Knowledge for Elimination Recommendations study) at the Institute of Allergy, Immunology, and Paediatric Pulmonology at the Yitzhak Shamir Medical Centre, we recruited patients aged 4 years or older who were allergic to walnut, with or without co-allergy to pecan, hazelnut, and cashew.

Quality of Life of Food-Allergic Patients Before, During, and After Oral Immunotherapy.

Background: Oral immunotherapy (OIT) for food allergy is demanding but data on patients' quality of life (QOL) throughout the process are limited.

Objective: To characterize changes in QOL of food-allergic patients during and after OIT.

Methods: In a prospective cohort study, the Food Allergy Quality of Life Questionnaire-Parental Form (FAQLQ-PF) was administered to parents of 191 consecutive children aged 4 to 12 years undergoing OIT for food allergy.