Yuu Okada, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Noriyuki Yanagida, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Sakura Sato, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Makoto Nisihino, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Takashi Inoue, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Mikita Yamamoto, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Mari Takei, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Ayako Ogawa, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Kanako Ogura, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Kenichi Nagakura, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Shigehito Emura, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Tomoyuki Asaumi, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Hirotoshi Unno, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Tetsuharu Manabe, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Kiyotake Ogura, MD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Katsuhito Iikura, MD, PhD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Motohiro Ebisawa, MD, PhD
,
Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
Background: The purpose of this study was to evaluate efficacy and safety of oral immunotherapy (OIT) to multiple allergens for a patient with multi nut allergy.
Methods: We enrolled a 22 year-old man who had peanut (Pn), cashew nut (Cas), and walnut (Wal) allergy. He had completely eliminated peanut and tree nuts since he experienced swelling of the face after peanut intake at the age of 1. Allergen specific IgE (sIgE) (kU/l) was 11.6 for Pn, 3.87 for Cas, and 6.08 for Wal. Open oral food challenge of each nut was performed before OIT. Baseline eliciting dose (g) was 0.5 for Pn, 1.1 for Cas, and 3.0 for Wal. From the day of admission, he took 10 mg of loratadine before nuts intake. On the day of admission, double blind placebo controlled food challenge (DBPCFC) was performed. The challenged food was made by mixing equal amounts of Pn, Cas, and Wal. From the 2nd to 4th hospital day, he took mixed nut powder which contained equal amounts of the three nuts twice a day. During his stay, we adjusted the amount so that he would not experience severe symptoms at home. After discharge, he took mixed nut powder once a day after taking loratadine. We investigated changes in symptom occurrence and allergen sIgE to evaluate the outcome.
Results: During DBPCFC, he experienced moderate abdominal pain at 1.5 g of total nut (0.5 g of each nut). On the 2nd hospital day, he experienced generalized erythema, persistent cough, and moderate abdominal pain at 1.5 g. After the amount was decreased to 0.5 g of total nut, he only experienced pruritis of throat and mild abdominal pain. After discharge, he continued to take 0.5 g. Symptoms at home were pruritis of throat, mild abdominal pain, and diarrhea 1 time, which rarely needed treatment. Symptom occurrence in the first 10 weeks was 100% for any symptoms (ANY), 85% for mucotaneous symptoms (MU), and 76% for gastrointestinal symptoms (GI). The occurrence from week 21 to 30 was decreased to 45% for ANY, 43% for MU, and 19% for GI. Allergen sIgE was temporarily increased to 47.4 for Pn, 9.00 for Wal, and 18.0 for Cas at 1 month, and decreased to 27.6 for Pn, 4.88 for Wal and 5.94 for Cas at 6 months.
Conclusions: OIT to multiple allergens for multi nut allergy could contribute to decrease of symptom occurrence and allergen sIgE.
