Oral Specific Desensitization in Food-Allergic Children

Abstract

The possibility of obtaining oral desensitization in patients with food allergy is still a matter of debate. We decided to evaluate the safety and efficacy of standardized protocols for oral desensitization with the most common food allergens. Forty-two children (ages up to 16 years) diagnosed as affected by food allergy (on the basis of clinical history, skin prick tests, measurement of specific IgE, and double-blind, placebo-controlled food challenge) underwent a sublingual-oral desensitizing treatment according to new standardized protocols. The control group consisted of 10 patients who followed an elimination diet. The treatment was successfully completed by 85.7% of the patients. Specific IgE showed a significant decrease, while specific IgG(4) showed a significant increase, in all treated patients. The immunological modifications observed in our patients lead us to hypothesize that oral tolerance may be mediated by the same mechanisms as those involved in traditional desensitizing treatments for respiratory and insect sting allergy.

Diagnosing and Managing Common Food Allergies

“…Desensitization refers to a temporary clinical state in which allergen exposure fails to cause allergic symptoms, whereas tolerance indicates clinical nonreactivity to allergen exposure even after long periods of abstinence. Five studies gave oral immunotherapy [34][35][36]38,39 and 2 studies gave subcutaneous immunotherapy. 37,40 Immunotherapy was somewhat effective for desensitization but tolerance and safety were inadequately evaluated.…”

Clinical Studies in Oral Allergen-Specific Immunotherapy: Differences among Allergens

“…The optimal dose and length of therapy is also unclear. Previous studies on OIT have used a variety of doses [6,13,16,25] and protocols are heterogeneous, making comparisons among them difficult. In 2012, Keet et al [11] demonstrated that sublingual immunotherapy (SLIT) followed by OIT was much more effective for desensitization than SLIT alone.…”

Allergen-Specific Immunotherapy for Food Allergy: Latest Advances in Vaccines

“…However, SLIT is not currently recommended for treatment of food allergy [34]. Only few studies have been done in peanut, nuts, kiwi, peach and cow´s milk allergy [35][36][37][38][39], and they showed lower frequencies of adverse reactions compared with OIT, which is likely due to lower doses of allergen administration and the capacity of the mouth mucosa to induce intestinal tolerance. However, the efficacy of SLIT is still debated and characterization of regulatory cells and mechanisms at the buccal mucosa are emerging [40].…”