Immunotherapeutic Approaches to Peanut Allergy Treatment-Pre-Clinical and Clinical Studies: A Comprehensive Review
Peanut allergy is a prevalent and potentially life-threatening condition affecting millions of people worldwide, necessitating strict dietary vigilance. Despite its widespread impact, current treatment options are predominantly limited to allergen avoidance and emergency management of allergic reactions. This review explores contemporary immunotherapeutic strategies aimed at achieving long-term relief for individuals with peanut allergy. We conducted a comprehensive literature review to discuss different treatment approaches, such as subcutaneous immunotherapy (SCIT), epicutaneous immunotherapy (EPIT), oral immunotherapy (OIT), and sublingual immunotherapy (SLIT), focusing on their mechanisms, efficacy, and safety profiles. Additionally, the review delves into novel approaches such as monoclonal antibodies targeting IgE and other critical immune pathways, adjuvanted therapies utilizing nanoparticles and gut microbiota, and advances in adoptive cell therapy including CAR-T cells and regulatory T cells. Furthermore, we highlight some clinical trials that test the efficacy and safety of these novel immunotherapeutic approaches in patients with peanut allergy. Collectively, we provide an overview of advancements in immunotherapeutic interventions for peanut allergy and recommendations for personalized immunotherapy regimens, ultimately paving the way for more effective treatment strategies.
https://doi.org/10.3390/jcm14061902
Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients
Background: Peanut oral immunotherapy (pOIT) protocols typically remain below the threshold for reaction during the initial dose escalation (IDE) day. However, some patients may have higher thresholds for reaction or may not have an ongoing peanut allergy. Objective: We sought to characterize the response to an accelerated initial dose escalation (A-IDE) for qualifying low-risk peanut-allergic patients younger than 4 years in which IDE progressed to a full peanut oral food challenge as tolerated. Methods: Records of 76 pOIT patients younger than 4 years were reviewed. Those with history of peanut reaction with peanut allergy testing of less than 95% positive predictive value for failed oral food challenge were offered an A-IDE. A-IDE proceeded stepwise until patients refused dosing, any reaction occurred, or they tolerated the challenge (cumulative dose: 4000 mg peanut protein). If the A-IDE was not tolerated, patients completed pOIT. Results: From April 2022 to February 2024, 16 patients participated in an A-IDE. Eleven (68.8%) tolerated the 4000 mg cumulative dose, demonstrating resolution of their peanut allergy. The remaining had mild symptoms not requiring epinephrine. Mean pOIT starting dose following A-IDE was 450 mg (vs 25 mg in standard pOIT). Maintenance dosing was reached with a mean of 5.2 visits (vs 9.7 in standard pOIT). Conclusions: Nearly 70% of low-risk patients younger than 4 years with previous diagnosis of peanut allergy tolerated a full peanut serving when initiating pOIT. This indicates the importance of diagnostic peanut challenge to selected patients before initiating OIT.
https://doi.org/10.1016/j.jacig.2025.100442
Update on hazelnut allergy: Allergen characterization, epidemiology, food processing technique and detecting strategy
Hazelnuts are popular among people due to their dense nutrient component. However, eating them may be quite dangerous for those who are allergic. To improve food safety, this research examines current developments in the characterization, processing, and detection of hazelnut allergens. The identification and molecular knowledge of certain proteins that cause allergic responses are necessary for the characterization of hazelnut allergens. Proteomics and genomics are two techniques that have helped to advance our knowledge of hazelnut allergens and facilitate the creation of more precise diagnostic instruments. One important factor to reduce but not to eliminate the exposure to hazelnut allergens is food processing. The extractability of hazelnut proteins with regard to food processing plays a crucial role in determining allergenicity. Innovative technologies have been created to lessen allergenicity in foods containing hazelnuts while preserving their flavor and quality. These technologies include thermal and nonthermal processing techniques. To further safeguard consumers with hazelnut allergies, innovations in ingredient labeling and cross-contamination avoidance techniques have been put into place. For the purpose of management, if foods contain hazelnut, they must label it. Technological developments in analytical methods, including mass spectrometry, polymerase chain reaction, and enzyme-linked immunosorbent assays, have made it possible to identify hazelnut allergens with high specificity and sensitivity in a range of dietary matrices. Moreover, the advancement of point-of-care testing instruments presents the possibility of prompt on site identification, hence enhancing food safety for people with hazelnut allergies. The multidisciplinary efforts of researchers, food technologists, and allergists to enhance the safety of products containing hazelnuts are highlighted in this study.
https://doi.org/10.1111/1541-4337.70098
Efficacy and Safety of Epicutaneous Immunotherapy in Peanut-allergic Children with Atopic Comorbidities
Background: There is a high prevalence rate of atopic comorbidities, including atopic dermatitis (AD), asthma, and concomitant food allergy (CFA), in children with peanut allergy. Objective: To evaluate whether concomitant atopic comorbidities affect the safety and efficacy of VIASKIN® peanut patch (VP250). Methods: EPITOPE was a phase 3, double-blind, placebo-controlled trial designed to assess treatment response to VP250, as measured by eliciting dose at 12 months, in peanut-allergic children aged 1 through 3 years. This subgroup analysis assessed response rates for prespecified subgroups, including children with asthma, AD/eczema, and CFA. The safety profile of VP250 was evaluated by atopic condition in all randomized participants who received at least 1 dose. Results: Responder rates were significantly greater with VP250 vs placebo, irrespective of the presence of atopic conditions. There was no significant interaction effect between participants with an atopic comorbidity vs those without. The safety profile was generally similar across subgroups without any additional safety signals. There was no clinically meaningful change in severity of AD in those receiving VP250, regardless of baseline AD status. Rates of anaphylaxis were higher in those with AD or CFA receiving VP250 vs those without; however, these imbalances were also observed in the placebo group. Conclusion: The results suggest that 12 months of treatment with VP250 was effective in desensitizing peanut-allergic children aged 1 through 3 years, with no difference in efficacy and a favorable safety profile, regardless of the presence of atopic comorbidities.
https://doi.org/10.1016/j.anai.2025.04.002
Umbrella Review of Systematic Reviews and Meta-Analyses on the Consumption of Different Food Groups and the Risk of Overweight and Obesity
Background/objectives: Dietary choices play an essential role in energy balance and weight gain. This systematic umbrella review investigates the association between the intake of various food groups (whole grains, refined grains, fruits, vegetables, nuts, legumes, fish, eggs, total dairy, red meat, white meat, processed meat, added sugar, and sugar-sweetened beverages) and their associations to the risk of obesity and being overweight. Methods: We systematically searched Medline, Embase, Web of Science, and Epistemonikos for systematic reviews and meta-analyses. A total of 2925 articles were screened, and 13 articles were included in our analysis. Results: For each food group, data included a mean of 166,100 participants and 36,760 cases, ranging from 19,885 participants and 7183 cases for red meat to 520,331 participants and 91,256 cases for nuts. Heterogeneity was high for most of the food groups except for whole grains and sugar-sweetened beverages. The quality of the most comprehensive meta-analyses was high for all food groups, except for processed meats, which was of low quality. High intakes of whole grains, legumes, nuts, and fruits are associated with a reduced risk of overweight and obesity. In contrast, high intakes of red meat and sugar-sweetened beverages are associated with increased risk of overweight and obesity. No significant results were found for the remaining food groups, and no meta-analysis was found for fish, eggs, white meat, and added sugars. Conclusions: Diets rich in whole grains, legumes, nuts, and fruits are associated with a lower risk of developing obesity and being overweight. In contrast, diets high in red meat and sugar-sweetened beverages are associated with an increased risk of overweight and obesity.
https://doi.org/10.3390/nu17040662
Consumption of tree nuts as snacks stimulates changes in plasma fatty acid profiles and adipose tissue gene expression in young adults at risk for metabolic syndrome
Background and aims: The prevalence of metabolic syndrome has been increasing in young adults, concomitant with the occurrence of increased abdominal adiposity. We previously reported that consuming tree nuts, as replacement for typical high-carbohydrate snacks, reduces visceral fat and waist circumference in young adults who have one or more metabolic syndrome risk factors. We aimed to investigate the effects of tree nuts snack consumption on plasma and adipose tissue fatty acid profiles along with changes in the expression of adipose tissue genes involved in thermogenesis, glycemia, adipocyte signaling, lipolysis, and immunity. Methods: A randomized parallel-arm 16-week intervention trial was conducted in 84 adults aged 22-36 years. Participants in both groups were provided with caloric goals for weight maintenance, daily menus, and pre-portioned snacks at every other week visits with study registered dietitians. Changes in dietary fatty acid intakes, plasma and abdominal subcutaneous adipose tissue (SAT) triglycerides fatty acid profiles using gas-liquid chromatography, and the expression of 241 genes in abdominal SAT were evaluated. Results: Consuming tree nuts snacks increased mono- and polyunsaturated fatty acid intakes yielding a 9-fold greater dietary unsaturated to saturated fat ratio. The tree nuts snack group also had significantly greater improvements in plasma 16:1/16:0 ratio; plasma phospholipids oleic and gamma linolenic acid content; plasma diglycerides, triglycerides, and cholesterol esters oleic acid content; and total plasma monounsaturated fatty acids. While abdominal SAT only showed trends for increased oleic acid content and unsaturated to saturated fat ratio, the tree nuts snacks participants had altered expression of 13 genes in abdominal SAT that have roles in nutrient sensing, energy homeostasis, and vulnerability to obesity. Conclusions: Replacing typical high-carbohydrate snacks with tree nuts results in more favorable dietary, plasma, and adipose tissue fatty acid profiles that could aid in preventing the development of excess adiposity and cardiometabolic disease states including metabolic syndrome.
https://doi.org/10.1016/j.clnu.2025.03.002
Optimal dietary patterns for healthy aging
As the global population ages, it is critical to identify diets that, beyond preventing noncommunicable diseases, optimally promote healthy aging. Here, using longitudinal questionnaire data from the Nurses' Health Study (1986-2016) and the Health Professionals Follow-Up Study (1986-2016), we examined the association of long-term adherence to eight dietary patterns and ultraprocessed food consumption with healthy aging, as assessed according to measures of cognitive, physical and mental health, as well as living to 70 years of age free of chronic diseases. After up to 30 years of follow-up, 9,771 (9.3%) of 105,015 participants (66% women, mean age = 53 years (s.d. = 8)) achieved healthy aging. For each dietary pattern, higher adherence was associated with greater odds of healthy aging and its domains. The odds ratios for the highest quintile versus the lowest ranged from 1.45 (95% confidence interval (CI) = 1.35-1.57; healthful plant-based diet) to 1.86 (95% CI = 1.71-2.01; Alternative Healthy Eating Index). When the age threshold for healthy aging was shifted to 75 years, the Alternative Healthy Eating Index diet showed the strongest association with healthy aging, with an odds ratio of 2.24 (95% CI = 2.01-2.50). Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products were linked to greater odds of healthy aging, whereas higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both) were inversely associated. Our findings suggest that dietary patterns rich in plant-based foods, with moderate inclusion of healthy animal-based foods, may enhance overall healthy aging, guiding future dietary guidelines.
https://doi.org/10.1038/s41591-025-03570-5
Research Links Higher Nut Consumption to Healthy Aging
The study tracked the dietary patterns of more than 100,000 participants for more than 30 years
A study published recently in the prestigious journal Nature Medicine sought to examine the relationship between dietary patterns and healthy aging. The prospective study, which followed 105,015 participants for up to 30 years, is one of the most comprehensive studies ever conducted on this topic.
Researchers found that adherence to healthy dietary patterns during midlife was strongly associated with healthy aging, defined as reaching age 70 while maintaining cognitive, physical, and mental health and being free of major chronic diseases. The study compared eight dietary patterns, with the Alternative Healthy Eating Index (AHEI) showing the strongest association with healthy aging. People in the highest AHEI quintile had 86% greater odds of achieving healthy aging compared to those in the lowest quintile.
The study identified the specific dietary factors that were most beneficial for healthy aging. Higher consumption of nuts —along with fruits, vegetables, whole grains, unsaturated fats, legumes, and low-fat dairy— was consistently associated with better outcomes, while higher intake of trans fats, sodium, and red and processed meats were linked to poorer outcomes.
The findings provide evidence that adherence to healthy dietary patterns that include nuts, among other dietary factors, represents a potential strategy for healthy aging.
Tessier, A. J., Wang, F., Korat, A. A., Eliassen, A. H., Chavarro, J., Grodstein, F., Li, J., Liang, L., Willett, W. C., Sun, Q., Stampfer, M. J., Hu, F. B., & Guasch-Ferré, M. (2025). Optimal dietary patterns for healthy aging. Nature Medicine, 10.1038/s41591-025-03570-5. Advance online publication
Study Shows Replacing High-Carb Snacks With Tree Nuts May Reduce Metabolic Risk Factors
Snacking on nuts may positively alter blood chemistry and gene expression in young adults
A recent study published in Clinical Nutrition investigated how replacing high-carbohydrate snacks with tree nuts affects metabolic health in young adults with risk factors for metabolic syndrome.
In this randomized 16-week intervention trial, 84 adults aged 22-36 years were randomly assigned to consume either mixed tree nuts (almonds, walnuts, pecans, macadamias, hazelnuts, pistachios, and cashews) or high-carbohydrate snacks (pretzels, crackers, and granola bars) as 15-20% of their daily caloric intake. The study integrated analysis of dietary intake, plasma and adipose tissue fatty acid profiles, and gene expression in abdominal subcutaneous adipose tissue to assess the metabolic effects of tree nut consumption.
The findings showed that consuming tree nuts significantly improved dietary fatty acid profiles, resulting in a ninefold greater unsaturated to saturated fat ratio compared to the carbohydrate snack group. These dietary changes translated into improvements in plasma fatty acid composition, including increased levels of beneficial fatty acids like oleic acid and linoleic acid. Moreover, the tree nuts group showed altered expression of 13 genes in abdominal adipose tissue related to thermogenesis, lipolysis, glycemia regulation, and immune function.
The researchers concluded that replacing high-carbohydrate snacks with tree nuts results in more favorable dietary, plasma, and adipose tissue fatty acid profiles, which could help to prevent excess adiposity and lower the risk of cardiometabolic diseases, including metabolic syndrome.
This study received a grant from the INC NREF.
Widmer, A., Lillegard, K., Wood, K., Robles, M., Fan, R., Ye, F., Koethe, J. R., & Silver, H. J. (2025). Consumption of tree nuts as snacks stimulates changes in plasma fatty acid profiles and adipose tissue gene expression in young adults at risk for metabolic syndrome. Clinical Nutrition (Edinburgh, Scotland), 48, 25–34. Advance online publication.
Study Links Daily Snacking on Almonds to Improved Gut and Metabolic Health
Almonds were also associated with improved cardiometabolic and inflammatory markers
A recent study published in npj Science of Food investigated how daily almond consumption affects gut and metabolic health in adults with overweight or obesity.
Researchers conducted a randomized, crossover-controlled feeding trial involving 15 adults, comparing a standard American diet with an isocaloric version that included a daily supplement of 42.5 grams of almonds over four weeks.
The findings showed that almond consumption significantly altered the gut microbiome, increasing beneficial bacteria such as Faecalibacterium prausnitzii and reducing opportunistic pathogens. This rebalancing of gut microbes fostered healthier ecological niches, thanks to symbiotic interactions between microbes and their metabolites. The almond diet also led to elevated levels of beneficial monosaccharides and greater microbial consumption of amino acids.
Beyond gut health, the study highlighted broader metabolic benefits. Regular almond intake was associated with improved metabolic homeostasis, driven by what researchers described as a “ketosis-like effect.” Participants also showed reduced markers of inflammation and improvements in hormones related to satiety. In short, the research suggests that adding almonds to your daily snack routine may offer a simple and tasty way to support gut health and improve cardiometabolic markers.
This study was supported by funding from the Almond Board of California.
Park, G., Johnson, K., Miller, K., Kadyan, S., Singar, S., Patoine, C., Hao, F., Lee, Y., Patterson, A. D., Arjmandi, B., Kris-Etherton, P. M., Berryman, C. E., & Nagpal, R. (2025). Almond snacking modulates gut microbiome and metabolome in association with improved cardiometabolic and inflammatory markers. NPJ Science of Food, 9(1), 35.