Oral Allergy Symptoms and Pollen Sensitization in Tree Nut Allergic Subjects Receiving Walnut Oral Immunotherapy (WOIT)
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Amika Sood, Amy M. Scurlock, MD, Mallikarjuna R Rettiganti, PhD, Anne M. Hiegel, RN CRC, James D Sikes, Suzanne E House, Jennifer N Payne, Jessica L Bettis, Sarah E Beckwith, Tamara T. Perry, MD, Robbie D. Pesek, MD, Josh L. Kennedy, MD, Peggy L. Chandler, APN, Chunqiao Luo, MS, Stacie M. Jones, MD
Rationale: This study aims to correlate oropharyngeal symptoms and aeroallergen sensitization in multi-tree nut allergic subjects participating in a WOIT trial.    

Methods: Nineteen subjects (14 randomized and 5 screen failures) underwent baseline placebo-controlled oral food challenges (OFCs) to walnut and a test tree nut; 12 randomized subjects completed OFCs after 38 weeks of WOIT. Oral allergy symptoms were documented during OFC and correlated with pollen-specific IgE and season of OFC using Fisher’s exact test.   

Results: Baseline walnut OFCs (n=14 randomized subjects) were complicated by oral pruritus (36%), pharyngeal pruritus (79%), or either (93%). Baseline OFCs to the test tree nut revealed similar results:  21% oral pruritus, 79% pharyngeal pruritus, and 86% either. Screen failures had similar symptoms during baseline OFC (p=NS). Following 38 weeks of WOIT, oropharyngeal symptoms were reduced in WOIT subjects during walnut OFC (17%-oral; 17%-pharyngeal; 33%-either) and test tree nut OFC (17%-oral; 17%-pharyngeal; 25%-either). Oral allergy symptoms were noted in only 1 placebo OIT subject. Specific IgE levels were elevated in randomized subjects to grass (50%), tree (71%), and weed (29%) pollens at baseline; however, pollen-specific IgE levels and season of OFC completion were not significantly correlated with symptoms during OFC at either time point.

Conclusions: Oral allergy symptoms and pollen sensitization are common in multi-tree nut allergic subjects participating in a WOIT trial and complicate clinical assessment during OFC.   Oral symptoms appear to be reduced after 38 weeks of walnut OIT and do not correlate with pollen sensitization or season in which OFC is completed.