Branching Out: Oral Immunotherapy for Tree Nut Allergy

Oral immunotherapy (OIT) is a well-established treatment for peanut allergy, but we have less experience using OIT to treat patients with tree nut allergy. Researchers performed a real-world effectiveness analysis of OIT in 95 children 9 to 70 months of age who had allergies to cashews, walnuts, or both; these are the two most common tree nut allergens (Figure 1). Although the report is short on details, children consumed nut powder, nut butter, or nut milk, increasing doses every 2 to 4 weeks to a target daily dose of 300 mg of cashew protein, walnut protein, or both. The report does not specify if dose escalation occurred in the office or at home.