OIT protocol
Two different strategies were used to start the OIT (see Supplementary
table 1). All 24 patients with CN allergy and 20 out of 38 patients
(52%) with peanut allergy, initiated OIT with an open OFC. The OFC
protocol, following international guidelines, was stopped when symptoms
appeared, in line with the PRACTALL consensus
report20. The dosage at symptoms onset was considered
the individual reactive dose. For these patients, OIT began with the
highest tolerated OFC dose. 18 high-risk peanut patients started with an
initial dose escalation, gradually increasing doses to 0.0064 g of nut
protein as the OIT starting dose (Supplementary table 1).
Patients increased their nut intake by 20-30% every two weeks,
targeting a 1 g nut protein maintenance dose. Increases were avoided
during pollen season to reduce side effects in patients with seasonal
symptoms, or when reactions occurred.
After reaching the maintenance dose of 1 g nut protein, patients
continued this regimen for four weeks daily and then every other day for
18-24 months. One patient in the CN group and two in the peanut group
bypassed the up-dosing phase as they tolerated the maintenance dose
directly during the initial OFC. Following the maintenance period,
another OFC was conducted. Those who consumed a total of 4.4 g of nut
protein were considered desensitized, allowed to freely consume the nut
but advised to intake at least 1g of nut protein twice a week. In case
of intolerance during this second OFC, patients returned to their
previous maintenance regimen.