The current state of food allergy therapeutics

Abstract

The prevalence of IgE mediated food allergy is an increasing public health concern. The current standard of treatment is strict avoidance of the offending food(s). There are no FDA approved treatments for food allergy. This review will provide an overview of strategies currently under investigation for the treatment of food allergy. The main focus of research has been directed at various forms of immunotherapy, including oral, sublingual and epicutaneous delivery routes. While oral immunotherapy (OIT) has shown the greatest promise for efficacy in terms of amount of protein that can be ingested, it has also demonstrated less tolerability and a less favorable safety profile as compared to sublingual immunotherapy (SLIT) and epicutaneous immunotherapy (EPIT), which offers the least protection but has the best safety and tolerability profile. Investigation is also underway for modified antigens that may be used for immunotherapy and for adjuncts that may help facilitate immunotherapy, including biologics such as anti-IgE therapy, and also probiotics. There are also a number of preclinical concepts that are being evaluated to manipulate the antigens and/or the immune system that may one day be translatable to patients.

Therapeutic perspectives in food allergy

“…OIT essentially consists of the execution of a food challenge (FC) to assess the tolerating threshold. A minimum initial dose of a few milligrams is administered and then increased in 1-2 days, followed by a scaled dose increase every 1-2 weeks for 6 months [6]. This phase is followed by a maintenance period (i.e., a period without increase in dose) for more than 1 year at home (in some cases up to 3-5 yrs) and upon maintenance the acquired tolerance is evaluated by another FC.…”

“…After therapy has been stopped and after a diet for 1-2 weeks, a FC is repeated to verify sustained unresponsiveness [6]. OIT use is affected by serious secondary effects, such as major abdominal symptoms and anaphylaxis [6]. Most patients experience allergic reactions and, although generally mild, severe reactions have occurred.…”

“…Most patients experience allergic reactions and, although generally mild, severe reactions have occurred. Moreover, long-term adherence is unclear, which rises concerns given the low rates of long-term tolerance induction [6]. Another negative aspect is the loss of tolerance acquired one or more weeks after the end of therapy in the majority of patients who tend to discontinue the therapeutic dose over time.…”

“…In the last 20 years, several clinical studies have been conducted in the search for new therapeutic strategies in patients with food allergy. After the failure of injection immunotherapy, three different routes of administration, oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT), have been tested [6]. The purpose and goals of this manuscript is to review OIT, SLIT, and EPIT clinical trials on food allergies and to suggest advantages and limits of the different routes of immunotherapy administration.…”

Broad perspectives of allergen specific immunotherapy

“…Chen and Land 14 introduce platform concepts for food allergy immunotherapy. The choice of the delivery being considered today is between the oral, sublingual and epicutaneous routes with subcutaneous injections generally eschewed because of safety concerns.…”