Immunotherapy for Food Allergies in Children

Abstract

Food allergy is an increasingly prevalent problem all over the world and especially in westernized countries, and there is an unmet medical need for an effective form of therapy. During childhood natural tolerance development is frequent, but some children with cow's milk or hen's egg allergy and the majority of children with peanut allergy will remain allergic until adulthood, limiting not only the diet of patients but also their quality of life. Within the last several years, the usefulness of immunotherapy for food allergies has been investigated in food allergic patients. Several food immunotherapies are being developed; these involve oral, sublingual, epicutaneous, or subcutaneous administration of small amounts of native or modified allergens to induce immune tolerance. The approach generally follows the same principles as immunotherapy of other allergic disorders and involves administering small increasing doses of food during an induction phase followed by a maintenance phase with regular intake of a maximum tolerated amount of food. Oral immunotherapy seems to be a promising approach for food allergic patients based on results from small uncontrolled and controlled studies. Diet containing heated milk and egg may represent an alternative approach to oral immunomodulation for cow's milk and egg allergic subjects. However, oral food immunotherapy remains an investigational treatment to be further studied before advancing into clinical practice. Additional bigger, multicentric and hopefully randomized-controlled studies must answer multiple questions including optimal dose, ideal duration of immunotherapy, degree of protection, efficacy for different ages, severity and type of food allergy responsive to treatment.

Imunoterapi untuk Alergi Makanan: Mitos atau Realitas?

“…Karena makanan merupakan sesuatu yang sangat penting untuk pertumbuhan dan perkembangan anak-anak dan juga esensial untuk kelangsungan hidup, maka ketidakpastian tersebut memberikan beban psikologis yang sangat memengaruhi kualitas hidup pasien dan keluarganya. 11,12 Dalam beberapa tahun terakhir telah dikembangkan dan diteliti imunoterapi untuk alergi makanan. 10,11 Tujuan utama terapi tersebut adalah untuk mencapai toleransi oral secara paripurna.…”

“…10,11 Tujuan utama terapi tersebut adalah untuk mencapai toleransi oral secara paripurna. [11][12][13] Namun demikian, masih dipertanyakan apakah tujuan tersebut benar-benar dapat dicapai. Untuk itu, pada artikel ini dibahas mengenai beberapa jenis imunoterapi yang telah diujicobakan untuk beberapa jenis alergen makanan yang berbeda, protokol imunoterapi secara singkat, hasil evaluasi secara klinis dan imunologis, tingkat keamanan, dan tingkat keberhasilan imunoterapi makanan.…”

“…14 Imunoterapi alergi makanan mengacu pada upaya memaparkan pasien terhadap alergen makanan spesifik yang menjadi penyebab atau pemicu reaksi alergi, dengan dosis yang dinaikkan secara bertahap, dengan tujuan untuk mengurangi reaktivitas klinis pasien. 11,12 Dua istilah yang terkait dengan imunoterapi makanan adalah desensitisasi dan toleransi. Istilah "desensitisasi" mengacu pada kemampuan untuk meningkatkan dosis alergen makanan yang dapat menginduksi reaksi klinis pada seseorang yang sedang menjalani imunoterapi.…”

Immunotherapy for Food Allergies: A Myth or a Reality?

“…For OIT, the approach generally follows the same principles of the immunotherapy of other allergic disorders and involves adminisImmunotherapy for food allergies: a myth or a reality? future science group Review Praticò & Leonardi tering small increasing doses of food during an induction phase followed by a maintenance phase based on regular intake of a maximum tolerated amount of food [8]. In this regard, protein doses are increased over 1 day in rush protocols and continued over many weeks until a maintenance dose is reached.…”

Immunotherapy in allergy and cellular tests

“…OIT may offer a promising approach to induce specific oral tolerance to selected food allergens, though yet restricted to a small group of molecules, and can represent a potential strategy for long-term curative treatment of food allergy, 125 though many controversial problems about protocol and allergen dose yet exist, even for other AIT protocols. [143][144][145][146][147][148][149][150] The application of BAT in oral immunotherapy should consider also the role of secretory IgAs and their receptor on granulocytes. [151][152][153] Past reports have shown that secretory IgAs induce degranulation in IL-3 primed basophils.…”