A NEW study presented at the European Academy of Allergy and Clinical Immunology Congress 2025 has found that most children who undergo nut oral immunotherapy (N-OIT) can successfully achieve sustained unresponsiveness (SU) after a period of nut avoidance.
N-OIT, which involves regular consumption of a specific allergenic nut to build tolerance, has shown promise in desensitising allergic individuals. However, the ability to maintain this tolerance after stopping treatment had not been thoroughly evaluated until now.
This retrospective study reviewed the outcomes of 45 children who had completed N-OIT between November 2021 and January 2025. The children, with a median age of 12 and a majority being male, were tested for SU through an oral provocation test (OPT) following a three-month break from nut intake. Among them, 75.5% had additional allergic conditions such as allergic rhinitis, atopic dermatitis, food allergies, or asthma.
The patients underwent 47 OPTs in total, as two children were tested for more than one nut. The nuts tested included walnut, hazelnut, peanut, pine nut, cashew, and Brazil nut. The median duration of N-OIT varied by nut, ranging from 29 to 36 months. Of the 47 OPTs conducted, 46 were negative, indicating a high rate of SU achievement (97.7%). Only one child experienced a mild reaction after reintroducing hazelnuts, despite initially passing the OPT. This case was linked to partial compliance with the therapy and elevated allergen-specific IgE levels prior to treatment.
These findings suggest that most children can maintain tolerance to nuts even after a short period without exposure, following a structured course of N-OIT. The data support N-OIT as a practical, relatively safe, and effective approach in real-world clinical settings. However, the study also highlights the need for further research to refine treatment protocols and better define what constitutes sustained unresponsiveness.
Reference
Barni S et al. Retrospective cohort study to assess sustained unresponsiveness in children undergoing nut oral immunotherapy. Abstract 100291. EAACI Congress, 13-16 June, 2025.
