Emerging therapies for food allergy

Abstract

Food allergy is a common condition for which there are currently no approved treatments except avoidance of the allergenic food and treatment of accidental reactions. There are several potential treatments that are under active investigation in animal and human studies, but it is not yet clear what the best approach may be. Here, we review approaches that are currently in clinical trials, including oral, sublingual, and epicutaneous immunotherapy, immunotherapy combined with anti-IgE, and Chinese herbal medicine as well as approaches that are in preclinical or early clinical investigation, including modified protein immunotherapy, adjuvants, DNA vaccines, and helminth administration. We discuss the importance of fully exploring the risks and benefits of any treatment before it is taken to general clinical practice and the need for clarity about the goals of treatment.

Figures

Figure 1. Potential mechanisms by which specific immunotherapy to food may act.

Multiple cellular responses to immunotherapy may contribute to reduced immune activation, including deletion of effector Th2 cells, desensitization of mast cells and basophils, and induction of tolerogenic DCs. In addition, immunotherapy may promote allergen-specific Tregs, which in turn suppress effector T cells, reduce activation of mast cells and basophils, and trigger B cells to first increase IgG4 production and then decrease IgE production, leading to decreased activation of mast cells and basophils. Mechanisms of other therapeutic approaches (not shown) may include (a) inhibition of IgE binding (anti-IgE), (b) reduced basophil activation (FAHF-2), (c) reduced Th2 responses (FAHF-2, helminths), and (d) induction of tolerogenic DCs (DNA vaccines).