Food Allergies: Current and Future Treatments

Abstract

Food allergies are an increasingly public health problem, affecting up to 10% of children and causing a significant burden on affected patients, resulting in dietary restrictions, fear of accidental ingestion and related risk of severe reactions, as well as a reduced quality of life. Currently, there is no specific cure for a food allergy, so the only available management is limited to strict dietary avoidance, education on prompt recognition of symptoms, and emergency treatment of adverse reactions. Several allergen specific- and nonspecific-therapies, aiming to acquire a persistent food tolerance, are under investigation as potential treatments; however, to date, only immunotherapy has been identified as the most promising therapeutic approach for food allergy treatment. The aim of this review is to provide an updated overview on changes in the treatment landscape for food allergies.

Mechanisms of allergen-specific immunotherapy for allergic rhinitis and food allergies

“…In an attempt to reduce risk of adverse allergic reactions during AIT for FA, clinical trials have been investigating the combined administration of OIT with omalizumab and a phase I clinical trial confirmed that OIT with omalizumab is safer than OIT alone, with no severe adverse events being reported and rapid desensitization was also achieved [8,198]. Furthermore, Nadeau et al [199] also showed that up-dosing of food allergens to reach a maintenance phase can be more rapid after addition of omalizumab to OIT and hence, combined administration of OIT and omalizumab has improved safety profile with retained efficacy [64].…”

“…In addition, a pandemic increase in non-respiratory allergies such as food allergies (FA) has also been observed [7][8][9][10][11] and patients with FA have a higher risk of developing respiratory allergies [12][13][14]. FA is defined as an adverse immunological reaction to food [8,15], which may be IgE-mediated, non-IgE mediated (cell-mediated) or mixed (IgE and cell-mediated). IgE-mediated food reactions usually occur within minutes to 2 hours after exposure to allergen [16,17] while non-IgE-mediated food reactions are typically delayed from hours to weeks after intake of the allergen [18].…”

“…Indeed, as published in the "Finding a path to safety in food allergy: assessment of the global burden, causes, prevention, management and public policy" by the National Academies of Sciences, Engineering, and Medicine (NASEM), it is difficult to assess the true prevalence of FA [22]. The quality of life of children with FA and their family is significantly reduced due to dietary and social restrictions, severe reactions, and fatalities that might be caused by FA [8,23]. Current management of an IgE-mediated FA is limited to allergen avoidance, patient education on prompt recognition of symptoms and emergency treatment of allergic reactions [8].…”

“…The quality of life of children with FA and their family is significantly reduced due to dietary and social restrictions, severe reactions, and fatalities that might be caused by FA [8,23]. Current management of an IgE-mediated FA is limited to allergen avoidance, patient education on prompt recognition of symptoms and emergency treatment of allergic reactions [8]. However, there is low compliance to diet adherence [24].…”

“…However, there is low compliance to diet adherence [24]. Based on a similar concept to AIT for AR, AIT has been introduced to FA patients for managing their FA recently with an aim to restore immune tolerance to the food allergen and has been considered the most promising therapeutic approach for treating FA [8]. Indeed, the Food and Drug Administration has only recently approved OIT for peanut allergy with the use of AR101, a characterized and standardized peanut powder, in children and adolescents with peanut allergy after a previous phase 3 clinical trial (PALISADE) has demonstrated that treating children and adolescents with severe peanut allergy with AR101 resulted in desensitization after 6 months of the maintenance phase in these allergic individuals [25].…”