iii. Implications for research
The management options of patients with tree nut allergy need to be further investigated by researchers. Regarding specific immunotherapy, SLIT or OIT, more studies are needed, with well characterized participants by means of molecular allergens, which are better predictors of severity of tree nut allergy40-42.
In OIT more studies are needed to determine the optimal build-up phase, with or without adjuvant, and maintenance dose, which balance efficacy, safety, and compliance. The current knowledge of immune modulation during OIT43 does not support the acquisition of a permanent tolerance phenotype (SU). The frequency and the dose required to maintain desensitization are probably dependent on individual biomarkers, still not fully elucidated.
The use of biologics is an appealing option, especially for patients with allergic comorbidities, and they deserve further research.