Either way, again while I understand the theory of the approach, I think this is an even further derivative than the birch/Ara h 8 scenario you detailed above, and I would think there are steep barriers to it being successful. That may be because no one has tried this approach before, or that it has been tried (with either success or failure) and just never published. With respect to expanding this approach by feeding possibly cross-sensitizing foods within the legume family to try to lessen peanut allergy, there is no evidence I am aware of that this is effective. That said, it would be fantastic to find out of the box ways to help patients, and this seems an easy enough concept to study with more rigor.Ĭ. While I digress, theory is theory, and this potential would not be a reason why I would start a patient on birch AIT, or a benefit I’d really discuss with a patient for their consideration of starting birch AIT. I can think of infants eating a particular peanut coated puff as one example of how an anecdote shared between investigators inspires a major policy-shifting study. However, our field is full of one-off successes that eventually inspire more widespread adaptation and study. I understand the theory of the approach, but this remains in the realm of anecdotal success until more data emerge (ideally from controlled studies involving OFC) to better substantiate the findings. With respect to the reported success here of AIT, I’m glad that the patient is peanut tolerant now, but it is hard to entirely attribute this to the AIT. The JTFPP just researched this issue in their forthcoming diagnostic testing parameter and did not note there were sufficient number of studies (using a criteria where at least 50% of the patients had to undergo OFC to validate the component being tested) to support use of Ara h 8 testing for this specific indication.ī. The best evidence for Ara h 8 comes still from a limited number of studies reporting that patients with primarily oral/pharyngeal symptoms attributable to peanut (but not other symptoms) may singularly recognize Ara h 8 and not other proteins. Don’t get me wrong-I think there is good theoretical evidence for why this may be more true than false, and it is a popular belief that comes up in Q&A sessions on peanut allergy, but there are just not many data supporting this per se at present. There are a very limited amount of data supporting that birch sensitive patients may singularly recognize Ara h 8 and not other proteins within peanut, but how that translates to clinical findings in prospective challenge based studies is very poorly defined. His response is below.”īoth the use of Ara h 8 testing in this particular setting, as well as AIT for birch as a means to potentially desensitize someone to peanut are without published evidence, so it is hard to really comment on the validity of the strategy per se. Matt Greenhawt, an internationally recognized expert in food allergy. Protein characterisation and immunochemical measurements of residual macadamia nut proteins in foodstuffs. Geiselhart S, Hoffmann-Sommergruber K, Bublin M. Prevalence and severity of food allergies among US adults. BSACI guideline for the diagnosis and management of peanut and tree nut allergy. Stiefel G, Anagnostou K, Boyle RJ, et al. ![]() Foods that crossreact with cashew and pistachio. Cross-reactivity between papaya, mango, and cashew.Īmerican Academy of Allergy Asthma and Immunology. doi:10.2332/allergolint.10-OA-0222Īmerican Academy of Allergy Asthma and Immunology. ![]() Pistachio allergy-prevalence and in vitro cross-reactivity with other nuts. Noorbakhsh R, Mortazavi SA, Sankian M, et al. Cross-reactivity between aeroallergens and food allergens. Everything you need to know about tree nut allergy. doi:10.2147/JAA.S141636Īmerican Academy of Allergy Asthma and Immunology. Current perspectives on tree nut allergy: a review.
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