The use of biologics in food allergy

Abstract

Background Food allergy continues to pose problems due to its increased frequency and its increasingly high severity. In this context, alongside the traditional avoidance strategies of allergenic foods and desensitization through the cautious progression of exposure to foods in the context of oral immunotherapy (OIT), alternative strategies have made their way in the last decades. We review the possibilities of intervention in food allergy with the use of biological drugs capable of interfering with the synthesis of IgE, with their mechanisms of action, or with complex biological mechanisms that lead to the establishment of a food allergy. Methods Repeated Entrez PubMed searches using the template algorithm “Food allergy” and “biologics” or “Omalizumab” or “Dupilumab” or “milk desensitization” or “oral tolerance induction” or “oral immunotherapy” or “Etokimab” or “Tezepelumab” or “Quilizumab” or “Ligelizumab” or “Tralokinumab” or “Nemolizumab” or “Mepolizumab” or “Reslizumab” or “Benralizumab”. The authors’ clinical experience in paediatric allergy units of University hospitals was also drawn upon. Results The landscape in this context has changed dramatically over the past 10 years. We have acquired knowledge mainly on the effect of different types of anti‐IgE treatments in poliallergic patients with food allergy, and in patients treated with OIT. However, other mediators are being targeted by specific biologic treatments. Among them, the alarmins Il‐33 and TSLP, IL‐4 and IL‐13, eosinophil‐related molecules as IL‐6, IL‐8, IL‐10, IL‐12, and mostly IL‐5, and integrins involved in the pathogenesis of eosinophilic gastrointestinal diseases (EGIDs), as SIGLEC‐8. Conclusions The ever‐better knowledge of the mechanisms of food allergy allowing these developments will improve not only the perspective of patients with the most serious immediate food allergies such as anaphylaxis, but also those of patients with related diseases such as atopic dermatitis, eosinophilic esophagitis, and EGIDs. Biologics are also intended to complement OIT strategies that have developed over the years.

Cannabinoid WIN55212‐2 impairs peanut‐allergic sensitization and promotes the generation of allergen‐specific regulatory T cells

“…Food allergy is a worldwide health problem of increasing prevalence affecting 5–10% of the population in developed countries 1–4 . Although oral tolerance is the physiological response to ingested antigens, the breakdown of this tolerance leads to allergic sensitization 5–7 …”

“…[1][2][3][4] Although oral tolerance is the physiological response to ingested antigens, the breakdown of this tolerance leads to allergic sensitization. [5][6][7] The management and treatment of food allergy is mainly based on strict food avoidance and the use of epinephrine upon accidental ingestion. Peanut allergy constitutes the most common cause of food-induced anaphylactic reactions.…”

Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

“…The main treatment option of FA is dietary restriction, using rescue medications in case of severe allergic reactions ( 130 ). Moreover, novel therapies for FA treatment including microbiome, biologic agents, oral/sublingual/subcutaneous/epicutaneous immunotherapy (IT) were reported in the last decades ( 29 , 50 , 131 , 132 ). While results of recent OIT studies are encouraging, the major issue of OIT is the heterogeneity of study protocols including the duration of maintenance doses, primary end points, definition of desensitization, OFC protocols to evaluate desensitization, SU and safety profiles ( 35 ).…”

Phenotypes and Endotypes of Peach Allergy: What Is New?

“…The use of mast-cell stabilizers to prevent allergic reactions showed different clinical results, making it not advisable, so far, as a prophylactic strategy for food allergies in general and, therefore, for peach allergy as well [ 40 ]. The use of monoclonal antibodies, such as omalizumab and dupilumab, has been suggested instead in the treatment of food allergies, mostly as adjuvant therapy for immunotherapy rather than as a possible preventive strategy against the development of clinical symptoms in allergic patients [ 80 ].…”