Future therapies for food allergies

Abstract

Food allergy is an increasingly prevalent problem in westernized countries and there is an unmet medical need for an effective form of therapy . A number of therapeutic strategies are under investigation targeting foods that most frequently provoke severe IgE-mediated anaphylactic reactions (peanut, tree nuts, shellfish) or are most common in children, such as cow’s milk and hen’s egg. Approaches being pursued are both food allergen-specific and non-specific. Allergen-specific approaches include oral, sublingual and epicutaneous immunotherapy (desensitization) with native food allergens, and mutated recombinant proteins, which have decreased IgE-binding activity, co-administered within heat-killed E.coli to generate maximum immune response. Diets containing extensively heated (baked) milk and egg represent an alternative approach to food oral immunotherapy and are already changing the paradigm of strict dietary avoidance for food-allergic patients. Non-specific approaches include monoclonal anti-IgE antibodies, which may increase the threshold dose for food allergen in food-allergic patients, and a Chinese herbal formulation, which prevented peanut-induced anaphylaxis in a mouse model, and is currently being investigated in clinical trials. The variety of strategies for treating food allergy increases the likelihood of success and gives hope that accomplishing an effective therapy for food allergy is within reach.

Oral Immunotherapy for Food Allergy

“…Avoidance is currently the only approved therapy, and, although effective, avoidance diets can be difficult and may also put children at risk of nutritional deficiencies and impaired growth [5,6]. While at least 80% of milk-and eggallergic children are expected to achieve natural tolerance to these foods by adulthood, only 15%-20% of peanut-or tree nut-allergic individuals "outgrow" their allergies [7]. Peanut allergy is common in developed countries, affecting 1%-2% of children in the United States of America [4,8], and peanut is implicated in over half of all food allergy-related deaths in the United States of America [9,10].…”

Predicting Food Challenge Outcomes for Baked Milk: Role of Specific IgE and Skin Prick Testing

“…Recent evidence suggests that 70-80% of children with IgE-mediated cow's milk allergy will tolerate baked milk products. 5 Furthermore, children with milk allergy who tolerate baked milk products may outgrow their milk allergies faster than those who cannot tolerate baked milk, 1 possibly via the induction of milk-specific regulatory T cells. 6 Cow's milk proteins can be divided into two broad groups based on their solubility at pH 4.6: whey and casein.…”

Alergia alimentaria en pediatría: recomendaciones para su diagnóstico y tratamiento. Texto completo

“…Genera protección para reacciones graves con incremento del umbral de reactividad (desensibilización) y potencial tolerancia al finalizar la terapia. 108,109 Se asocia a efectos adversos frecuentes. Requiere la ingesta continua de la proteína alergénica para prevenir su reaparición.…”