Oral immunotherapy for food allergy

Abstract

Current management of food allergy involves strict avoidance, education on recognizing and managing allergic reactions, and carrying an adrenaline autoinjector. This approach is burdensome and associated with reduced quality of life. Patients with food allergy would benefit greatly from a treatment that could achieve desensitization or long-term tolerance. Recent studies have shown that oral immunotherapy (OIT) can induce desensitization and modulate allergen-specific immune responses; however, it remains uncertain whether OIT can induce long-term tolerance. Nevertheless, successful desensitization provides a major advance in management by reducing the risk of reaction to low amounts of allergen. Allergic reactions during OIT are common, although severe reactions are less common. Therefore, OIT should be performed in specialist centers under close medical supervision and would ideally be conducted as part of ongoing research studies. OIT holds promise as a novel approach to managing food allergy.

Immunotherapy in allergy and cellular tests

“…19,[123][124][125][126][127][128] Systematic reviews have tried to focus onto the issue and shed a light about current approaches in diagnosing and managing food allergy. 129 In peanut allergy, for example, many efforts have been recently made, 120,123,130 albeit doubts remain about reliability and clinical effectiveness of peanut allergy oral immunotherapy (OIT).…”

“…In subjects who develop food allergy, there is a failure or loss of oral tolerance acquisition to a limited number of food allergens. 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.…”

IgE-mediated food allergy

“…OIT can be performed via a rush protocol in a hospital setting or more slowly as an outpatient. Studies have shown that OIT can promote desensitization to milk, egg and peanut-allergic children even in cases of severe reactions marked by tolerance of larger amounts of food allergen and reduced allergenspecific IgE [38][39][40][41][42][43][44][45]. In a recent OIT follow-up study, six out of 13 patients with severe milk allergy tolerated milk doses as high as 16 000 mg of milk protein (16 ounces of milk) without a reaction.…”

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“…Recent advances regarding the complex pathogenesis of the disease shows that it is the result of the loss or lack of achieving oral tolerance to food allergens (3).…”