L’induction de tolérance orale à la noix de cajou et/ou à la pistache chez 50 patients : l’expérience rémoise

Abstract

IntroductionWe present the results of a retrospective study conducted for a pediatric DES dissertation on oral immunotherapy (OIT) with cashew nuts and/or pistachios. ObjectiveTo evaluate the efficacy of OIT (evolution of skin test size, specific IgE (IgEs), and total cumulative dose (TCD) tolerogenic and/or reactogenic at 12 months of OIT) and the adverse effects. Material and MethodCashew and/or pistachio OIT was proposed to 50 patients agedto 18 years with cashew and/or pistachio allergy or sensitization between January 2017 and June 2020.Tolerogenic or reactogenic TCD were determined when oral provocation test (OPT) were performed at 0, 6, and 12 months from the start of OIT. IgE and skin tests were performed before each OPT. ResultsAt 12 months of OIT the mean skin test size (mm) tended to decrease for cashew (from 9.4 to 6.4) and pistachio (from 8.62 to 5.04). Mean IgEs values (AU/mL) tend to decrease for cashew (from 3.61 to 2.02), rAnao3 (from 4.05 to 1.60) and pistachio (from 4.68 to 2.34). Mean DCT tended to increase (from 1042 to 5506mg). Allergic reactions were mild, 44% of patients at 1st OPT, 11% at 2nd OPT and 15% at 3rd OPT had grade 1 reactions according to Ring and Behrendt classification. 36% of patients were mild home adverse events (grade 1). 14% at 1st OPT had grade 2 reactions and 10% had grade 3 reactions. There were no reactions grade 4 or more. ConclusionCashew and/or pistachio OIT is effective, as evidenced by the decrease in skin tests and IgEs, but especially the increase in TCD protecting the child from anaphylactic accident and this without significant adverse effects either in day hospitalization or at home. The use of protocols with tolerogenic rather than reactogenic TCD and close medical and therapeutic education support contribute to these results.