Oral sublingual immunotherapy appears to work in the clinical setting and merits further research. To our knowledge this is the first report of an oral immunotherapy protocol for cashew and shrimp allergens in a large population that could potentially have relevance to the treatment of other OIT protocols.
Cashew or shrimp allergens are potential causes of a severe skin reaction. This reaction can be life threatening. Therefore, patients with a history of peanut allergy should avoid consuming shrimp or cashew nuts as well as raw shellfish.
There are multiple causes of hypersensitivity, some of which can be treated and corrected medically. In addition to the patient's history, testing of family members for their histocompatibility can provide insight for these causes. To prevent them, a physician should advise against taking the medicines of a prescribed type. The first step should be to discontinue these medications. The hypersensitivity can then be corrected by applying multiple steps of medication and an elimination of a specific type of hypersensitivity.
The most common treatments for drug hypersensitivity include avoidance, oral or intravenous steroids, and intravenous immunoglobulin (IVIG), as indicated by a previous history of anaphylaxis.
Recent findings we found hypoalgesia in the TII in patients with hypersensitivity disorders and allodynia in patients with other clinical diagnoses. Hypoalgesia increased and allodynia decreased with no significant correlation to hypersensitivity, suggesting that other etiology is required for both responses.
Symptoms like pain and itching of the eyes, mouth, skin or around the mouth with or without skin rash and dermatitis are all indications of hypersensitivity symptoms. It is important to realize that patients with allergy symptoms may have many different health problems, such as allergy-mediated asthma, asthma without atopy, or a drug reaction. This may take time to diagnose properly as many allergy symptoms overlap with more common health problems. Allergic diseases such as asthma must be suspected when a patient presents with breathing difficulties, shortness of breath, or chest pain. The differential diagnosis of the symptoms is critical to ensure timely care.
The prevalence of all-cause hypersensitivity was estimated to be 6.4% (range, 2.5%-13.0%) in the U.S. general population, of which 5.3% was allergic rhinitis. The prevalences were similar between subpopulations defined by age, sex, race, and geographic location. Over half (53.8%) of persons with a hypersensitivity reaction received emergency care because they were unresponsive to standard care and/or were hospitalized. A significant proportion of allergic patients will be admitted to an emergency department.
Currently no effective therapies exist to cure or prevent the hypersensitivity syndromes of allergies and asthma. Allergic patients who are treated before the diagnosis of a hypersensitivity disease often have a reduced risk of developing a hypersensitivity, but the risk of developing a hypersensitivity disease is still elevated.
Cashew and shrimp oral immunotherapy trials with cashew and shrimp allergens are ongoing in the US, US/Canada and Europe. It is recommended that future trials report their results in detail and that additional studies be undertaken. In the US/ Canada, the results of the placebo-controlled trials that were performed will not suffice as evidence to support their routine use. The efficacy of the products in reducing cross-reactions needs to be investigated. Until all the products (casein, peanut, tree nut, and seafood) demonstrated the efficacy in the clinical trials, it is not recommended for routine use.
Oral immunoallergic reaction to cashew or shrimp was more frequent in the study group than in those receiving only a placebo only in the cashew sensitivity group. Thus, the oral immunotherapy with cashew or shrimp has proven to be more effective than a placebo in children with cashew hypersensitivity.
Today, many physicians use the latest medical research when determining whether a patient should receive a specific treatment or not. Yet, this type of research is not always completely objective. The best approach for both patients and physicians will result when both the patient and physician are informed and working together.
The clinical trial power (PS power) of allergists in the US is estimated to be approximately 0.5. While the clinical practice guidelines suggest that a minimum PS of 0.5 and a minimum PS for immunotherapy of 0.75, the majority of US allergists do not conduct clinical trials for immunotherapy. The data indicated that, among those allergists who conduct clinical trials for immunotherapy, nearly all performed a clinical trial power analysis (PS power ≥ 0.7).