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Macadamia nut (primarily from the species *Macadamia integrifolia*) is utilized in clinical medicine both as a diagnostic allergen and as a therapeutic agent for oral immunotherapy (OIT). In the context of OIT, patients with confirmed macadamia nut allergy are administered gradually escalating doses of macadamia protein to induce immunological desensitization. This therapeutic process aims to shift the immune response from a Th2-biased allergic profile to a more tolerant state, characterized by the induction of regulatory T cells and the production of allergen-specific IgG4 antibodies, which compete with IgE for allergen binding. This desensitization raises the threshold for anaphylaxis upon accidental exposure. Additionally, macadamia nut extracts are used as diagnostic reagents in skin prick testing and in-vitro IgE assays to identify sensitized individuals.
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