Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated Food Allergy: The Transition to Clinical Practice

Abstract

Today, there is neither an effective nor an active treatment for food allergy. Allergy immunotherapy has been proposed as an attractive strategy to actively treat food allergy. Oral immunotherapy (OIT), also known as oral desensitization, is a method of inducing the body's immune system to tolerate a food that causes an allergic overreaction. It has been studied for the use in treatment of immunoglobulin E-mediated food allergy to the most common foods, including milk, egg, and peanut. OIT has been able to desensitize subjects to varying degrees. However, many questions remain unanswered, including efficient formulation, optimal dosing, and induction protocol to achieve full tolerance, transition of OIT to clinical practice, and maximal safety profile. This review focuses on the use of OIT as a new and active treatment for food allergy. The possibility of transition of OIT to clinical practice represents, in this field, the next pivotal step with the goal of improving the quality of life of patients with food allergy and their families.

Figures

FIG. 1.

Schematic representation of the putative mechanisms of action of oral immunotherapy (OIT), with the various pathways that T regulatory cells (Treg) can exert on cells of the innate and adaptive immune systems, leading to the suppression of a variety of effector cell functions. OIT works primarily through allergen activation of dendritic cells (DC) in the gut mucosa, resulting in effector cell modulation. (Adapted with permission from Dr. C. Akdis.) Color images available online at www.liebertpub.com/ped