Extension of home-based induction of sustained unresponsiveness to children with tree nut allergy
Monday, March 5, 2018
South Hall A2 (Convention Center)
Aida Gomez-Cardenosa, MD, Imelda Sexton, Jonathan O. Hourihane, MD FAAAAI

It is possible to induce sustained unresponsiveness with home dosing in children that develop mild reactions to high doses of peanut (PN) during oral food challenges (OFC) (Garvey et al JACI-IP, 2017). We have applied this process to children with tree nut (TN) allergy and revisited some who could not tolerate the PN program initially.


Subjects who “nearly pass” OFC1 with PN/TN, up-dose to 6 nuts daily at home over 3-6 weeks, then consume 6 nuts daily for 6 months. They then have a 2nd OFC, on dose. If they pass OFC2 they are considered desensitised, discontinue dosing for 6 weeks and have OFC3, off dose. After passing OFC3 they are considered to have achieved sustained unresponsiveness and advised to eat PN or TN at least 3 times weekly, indefinitely.


A further 13 children (9 PN, 2 cashew, 1 hazelnut, 1 pistacho) have joined the programm. The 4/9 PN allergic children who have completed the programm show sustained unresponsiveness (one initially withdrew but restarted successfully), 3 are up-dosing and 2 have withdrawn. The 4 TN allergic children are on maintenance (eating 6 nuts daily) until completing 6 months. From the published group of 16 PN allergic children, one child that withdrew is recently tolerating 6 peanuts daily.


We have shown home based programs induce sustained unresponsiveness in children that are nearly tolerant to TN, as previously shown for PN. The programm is flexible enough to allow re-entry and successful completion by subjects who could not tolerate it intially.