| Summary: | Background: Nut allergy diagnostics is complicated, due to asymptomatic sensitization and pollen-induced cross-sensitization. In addition, it is usually a life-long disease, and traditional treatment involves the avoidance of nuts and the administration of emergency medication in accidental exposures. Aims: To study nut allergy diagnostics by evaluating associations with nut- and birch pollen sensitizations and the performance of IgE microarray in peanut allergy diagnostics. In addition, to study the efficacy and safety of oral peanut immunotherapy and how the treatment modifies antibody profiles. Methods: We analyzed nut- and birch pollen sensitizations in a register of over 100,000 subjects from southern and northern Finland. We studied IgE microarray and avoidance diets in 102 patients who underwent a peanut challenge. In order to assess immunotherapy efficacy and antibody changes, we conducted an intervention study in which 39 patients received peanuts orally with increasing doses, and 21 patients served as controls. Results: Nut sensitizations associated strongly with birch pollen sensitization in both southern and northern Finland, and in this regard hazelnut, peanut, and almond sensitizations exhibited the strongest links. Up to 84% of hazelnut-sensitized patients had simultaneous sensitization to birch pollen, while the majority of sensitized subjects reported no or only mild oral symptoms from exposure to nuts. In the microarray, Ara h 2 and Ara h 6 were the most accurate allergens in discriminating between peanut allergy and tolerance. Commonly, peanut-sensitized patients avoided several nut species, but in the speciesspecific tests, sensitization to other nuts was infrequent. In immunotherapy, 33 (85%) of 39 patients achieved the target dose of 800 mg peanut protein (approximately four peanut kernels), and specific IgG4 increased strongly. No neosensitizations emerged in the microarray screening, but IgE levels decreased for the most important peanut allergens, Ara h 2 and Ara h 6. Conclusions: The ...
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