Integrating oral immunotherapy into clinical practice

Leonard, Stephanie A.; Laubach, Susan; Wang, Julie

doi:10.1016/j.jaci.2020.11.011

Cited by 33 publications

(33 citation statements)

References 86 publications

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“…Regardless of the route of administration, the assessment of efficacy and safety of AIT is complicated by variations in methodology. For instance, the dose of allergen administered during the escalation and maintenance phases is variable across clinical trials, as well as the duration of treatment and the form of allergen (e.g., powder, pill, cookie) (65)(66)(67). One substantive explanation for the high rate of serious AEs may be the high dose of allergen.…”

Section: Current and Investigative Treatments For Food Allergymentioning

confidence: 99%

The Road Toward Transformative Treatments for Food Allergy

et al. 2022

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A series of landmark studies have provided conclusive evidence that the early administration of food allergens dramatically prevents the emergence of food allergy. One of the greatest remaining challenges is whether patients with established food allergy can return to health. This challenge is particularly pressing in the case of allergies against peanut, tree nuts, fish, and shellfish which are lifelong in most patients and may elicit severe reactions. The standard of care for food allergy is allergen avoidance and the timely administration of epinephrine upon accidental exposure. Epinephrine, and other therapeutic options like antihistamines provide acute symptom relief but do not target the underlying pathology of the disease. In principle, any transformative treatment for established food allergy would require the restoration of a homeostatic immunological state. This may be attained through either an active, non-harmful immune response (immunological tolerance) or a lack of a harmful immune response (e.g., anergy), such that subsequent exposures to the allergen do not elicit a clinical reaction. Importantly, such a state must persist beyond the course of the treatment and exert its protective effects permanently. In this review, we will discuss the immunological mechanisms that maintain lifelong food allergies and are, consequently, those which must be dismantled or reprogrammed to instate a clinically non-reactive state. Arguably, the restoration of such a state in the context of an established food allergy would require a reprogramming of the immune response against a given food allergen. We will discuss existing and experimental therapeutic strategies to eliminate IgE reactivity and, lastly, will propose outstanding questions to pave the road to the development of novel, transformative therapeutics in food allergy.

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Section: Current and Investigative Treatments For Food Allergymentioning

confidence: 99%

The Road Toward Transformative Treatments for Food Allergy

et al. 2022

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“…As much as 200 mL of CM may not be necessary if sustained exposure to low allergen levels can cause immunological changes. OIT can increase the threshold dose for allergic reactions and substantially reduce the risk of severe allergic reactions after accidental ingestion of the allergen [22,30,80]. Levy et al reported that 180 mg of milk protein, the "minimal protective dose," might prevent allergic reactions after accidental consumption, even if unable to successfully intake 200 mL of milk.…”

Section: Are Lower Maintenance Doses Safer?mentioning

confidence: 99%

“…There is no published evidence on the minimal duration of the maintenance phase to achieve tolerance [53]. In the first place, there are no clinical or immunological criteria to evaluate the tolerance of food allergies [22,64], and there is no evidence that OIT can cure food allergies [80]. The first aim of OIT is to increase the reactive threshold and protect food-allergic individuals from severe allergic reactions due to accidental ingestion [22,80].…”

Section: Is More Prolonged Treatment More Effective?mentioning

confidence: 99%

“…In the first place, there are no clinical or immunological criteria to evaluate the tolerance of food allergies [22,64], and there is no evidence that OIT can cure food allergies [80]. The first aim of OIT is to increase the reactive threshold and protect food-allergic individuals from severe allergic reactions due to accidental ingestion [22,80]. SU refers to a state maintaining the clinical effect of OIT for a while after treatment cessation, which is different to true immunologic tolerance.…”

Section: Is More Prolonged Treatment More Effective?mentioning

confidence: 99%

“…Current studies assess the therapeutic effects of OIT by the achievement of SU, allowing for flexible consumption of the culprit food. The required duration to diagnose SU is not defined and varies from two weeks to six months [64,80] .…”

Section: Is More Prolonged Treatment More Effective?mentioning

confidence: 99%

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Oral Immunotherapy for Children with Cow’s Milk Allergy

2021

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Cow’s milk allergy (CMA) is one of the most common IgE-dependent food allergies in children. Some children develop severe and persistent CMA, with near-fatal reactions after exposure to trace amounts of cow’s milk (CM). Because milk and dairy products are included in various processed food products, it is difficult to completely remove milk, which negatively affects the quality of life of children with CMA. Oral immunotherapy (OIT) can alleviate food allergen-induced anaphylaxis under continuous ingestion of a little of the causative food. Children with severe CMA may benefit from OIT, but the treatment requires a long time and poses a risk of anaphylaxis. Moreover, in recent years, new therapies, including omalizumab, sublingual immunotherapy, and epicutaneous immunotherapy, have played the role of optional OIT. In this review, we present the current methods of and other attempts at OIT, and discuss OIT for safely treating CMA.

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A Review of Shared Decision-Making, Published Protocols, and Post-desensitization Strategies in Oral Immunotherapy (OIT)

Laubach,

Kim,

Greenhawt

et al. 2024

Curr Allergy Asthma Rep

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Purpose of Review The aim of this review is to highlight key published oral immunotherapy (OIT) protocols and post-desensitization strategies for the major food allergens and to cover important concepts to consider when evaluating OIT for food-allergic patients. Shared decision-making should help identify patient and family values which will help influence the type of evidence-based protocol and maintenance strategy to use. Recent Findings With food OIT emerging as a treatment option, there is a pressing need for patients, physicians, and other providers to have a nuanced understanding of the management choices available to them. There are now randomized controlled trials (RCT) of OIT for peanut, egg, milk, and wheat, and reports of cohorts of patients who have undergone OIT for tree nuts and sesame clinically. The current published protocols contain significant diversity in terms of starting dose, build-up schedule, maintenance dose, and even the product used for desensitization. Emerging data can help direct the long-term maintenance strategy for patients on OIT. Summary Based on patient and family values elicited through the shared decision-making process, an OIT protocol may be selected that balances the level of desensitization, potential side effects, frequency of clinic visits, and potential to induce sustained unresponsiveness, among other factors. Once maintenance dosing is reached, most patients will need to maintain regular exposure to the food allergen to remain desensitized. The option to transition to commercial food products with equivalent amounts of food protein as the OIT maintenance dose would simplify the dosing process and perhaps improve palatability as well. Less frequent or decreased OIT dosing can provide practical benefits but may affect the level of desensitization and safety for some patients.

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Integrating oral immunotherapy into clinical practice

Cited by 33 publications

References 86 publications

The Road Toward Transformative Treatments for Food Allergy

The Road Toward Transformative Treatments for Food Allergy

Oral Immunotherapy for Children with Cow’s Milk Allergy

A Review of Shared Decision-Making, Published Protocols, and Post-desensitization Strategies in Oral Immunotherapy (OIT)

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