{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T11:01:42Z","timestamp":1790938902160,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Walnut OIT has been observed to induce cross\u2010desensitization to hazelnut, but predictors of this response remain unclear. We sought to identify molecular predictors of hazelnut cross\u2010desensitization following walnut OIT, to help guide treatment decisions in these co\u2010allergic patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients with confirmed IgE\u2010mediated walnut and hazelnut allergy underwent walnut OIT. Patients achieving full walnut desensitization to 4\u2009g of walnut protein were re\u2010challenged to 4\u2010grams hazelnut protein after 6\u2009months. Baseline sera were obtained and competitive ELISA inhibition assays performed to evaluate serum IgE cross\u2010recognition of total walnut, total hazelnut and hazelnut component\u2010specific IgE. Results were compared between patients fully (4\u2010grams protein) or clinically (\u226530\u2010fold ED increase or mild reaction at full dose) cross\u2010desensitized to hazelnut and those who remained hazelnut allergic following walnut OIT.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, 12\/22 (54.5%) patients were fully cross\u2010desensitized and 14\/22 (63.6%) patients were clinically cross\u2010desensitized to hazelnut following walnut OIT. Among the latter, walnut inhibited total hazelnut\u2010specific IgE binding by a median of 95%, compared to 55% in those who remained hazelnut allergic (\n p<\/jats:italic>\n \u2009<\u2009.01). Similarly, walnut extract competed for IgE binding to hazelnut components Cor a 9 (\n p<\/jats:italic>\n \u2009=\u2009.003) and Cor a 16 (\n p<\/jats:italic>\n \u2009=\u2009.023) in the cross\u2010desensitized group following walnut OIT, but not in the persistent hazelnut allergic group. A \u226570% inhibition threshold accurately predicted cross\u2010desensitization in 93% of cases (\n p<\/jats:italic>\n \u2009<\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Walnut OIT can induce clinical cross\u2010desensitization to hazelnut in >60% of co\u2010allergic individuals. Competitive ELISA inhibition is a promising predictive tool, with potential to guide targeted and efficient OIT strategies in walnut\u2010hazelnut co\u2010allergic patients.<\/jats:p>\n \n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pai.70500","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T10:50:14Z","timestamp":1790938214000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inhibition studies to direct oral immunotherapy in walnut\u2010hazelnut co\u2010allergic patients (nut CRACKER study)"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5232-6342","authenticated-orcid":false,"given":"Yael","family":"Koren","sequence":"first","affiliation":[{"name":"Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (Assaf Harofeh) Medical Center Be'er Ya'akov Israel"},{"name":"Department of Pediatrics Shamir Medical Center, Zerifin, Israel, Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9089-9472","authenticated-orcid":false,"given":"Michael Y.","family":"Appel","sequence":"additional","affiliation":[{"name":"Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (Assaf Harofeh) Medical Center Be'er Ya'akov Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9523-5616","authenticated-orcid":false,"given":"Matan","family":"Elkan","sequence":"additional","affiliation":[{"name":"Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (Assaf Harofeh) Medical Center Be'er Ya'akov Israel"},{"name":"Department of Medicine Shamir Medical Center, Zerifin, Israel, Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4377-472X","authenticated-orcid":false,"given":"Liat","family":"Nachshon","sequence":"additional","affiliation":[{"name":"Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (Assaf Harofeh) Medical Center Be'er Ya'akov Israel"},{"name":"Department of Medicine Shamir Medical Center, Zerifin, Israel, Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0962-7814","authenticated-orcid":false,"given":"Lars","family":"Mattsson","sequence":"additional","affiliation":[{"name":"Thermo Fisher Scientific Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7779-3411","authenticated-orcid":false,"given":"Jonas","family":"Lidholm","sequence":"additional","affiliation":[{"name":"Thermo Fisher Scientific Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Levy","sequence":"additional","affiliation":[{"name":"Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (Assaf Harofeh) Medical Center Be'er Ya'akov Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8157-8143","authenticated-orcid":false,"given":"Arnon","family":"Elizur","sequence":"additional","affiliation":[{"name":"Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (Assaf Harofeh) Medical Center Be'er Ya'akov Israel"},{"name":"Department of Pediatrics Shamir Medical Center, Zerifin, Israel, Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1355-1533","authenticated-orcid":false,"given":"Michael R.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Institute of Allergy, Immunology and Pediatric Pulmonology Shamir (Assaf Harofeh) Medical Center Be'er Ya'akov Israel"},{"name":"Department of Pediatrics Shamir Medical Center, Zerifin, Israel, Affiliated to the Gray Faculty of Medical and Health Sciences, Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"issue":"9","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s11882-015-0555-8","article-title":"The prevalence of tree nut allergy: a systematic review","volume":"15","author":"McWilliam V","year":"2015","journal-title":"Curr Allergy Asthma 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