Allergy Asthma Respir Dis.  2014 Sep;2(4):229-235. 10.4168/aard.2014.2.4.229.

Oral immunotherapy for the treatment of immediate type food allergy

• Lee S

• KMID: 2262389
• DOI: http://doi.org/10.4168/aard.2014.2.4.229

Abstract

Food allergies continue to increase exponentially and therapies that can modify the natural course of disease is a recent top priority of the research. IgE-mediated food allergy represents both a promising and an intriguing disease of application for allergen specific immunotherapy. In particular, oral immunotherapy (OIT) may offer a novel effective therapeutic modality for persistent and severe forms of food allergies. In such patients, avoidance of the causative foods only may be insufficient because of the risk of unplanned exposure to causative foods. In patients with cow's milk, hen's egg, and peanut allergies, several recently published studies, including meta-analysis, confirmed the overall benefit of OIT. However, the definitive evidence of efficacy and safety with long-term therapeutic or disease-modifying effects is limited. In current protocols, entry indications, and initial-escalating-maintenance doses, the form of antigens, durations, and follow-up periods await to be standardized. Most of the clinical trials of OIT demonstrate effective desensitization, but the ability for inducing long-term tolerance remains to be improved, and the ratio of risks versus benefits of OIT should be considered in detail. The ultimate goal is extending OIT to primary care practice, but at this time, OIT remains within the purview of allergy specialists in terms of associated risk-benefit ratios, related safety, and long-term tolerance induction.

Keyword

Food allergy; Oral immunotherpay; Safety; Tolerance

MeSH Terms

Food Hypersensitivity*
Humans
Hypersensitivity
Immunotherapy*
Milk
Ovum
Peanut Hypersensitivity
Primary Health Care
Specialization

Reference

1. Pajno GB, Cox L, Caminiti L, Ramistella V, Crisafulli G. Oral immunotherapy for treatment of immunoglobulin E-mediated food allergy: the transition to clinical practice. Pediatr Allergy Immunol Pulmonol. 2014; 27:42–50.

2. Keet CA, Wood RA. Emerging therapies for food allergy. J Clin Invest. 2014; 124:1880–1886.

3. Pumphrey RS, Gowland MH. Further fatal allergic reactions to food in the United Kingdom, 1999-2006. J Allergy Clin Immunol. 2007; 119:1018–1019.

4. Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007; 119:1016–1018.

5. Liew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol. 2009; 123:434–442.

6. Schofield AT. A case of egg poisoning. Lancet. 1908; 1:716.

7. Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K. Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy. 2007; 62:1261–1269.

8. Skripak JM, Nash SD, Rowley H, Brereton NH, Oh S, Hamilton RG, et al. A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow's milk allergy. J Allergy Clin Immunol. 2008; 122:1154–1160.

9. Longo G, Barbi E, Berti I, Meneghetti R, Pittalis A, Ronfani L, et al. Specific oral tolerance induction in children with very severe cow's milk-induced reactions. J Allergy Clin Immunol. 2008; 121:343–347.

10. Pajno GB, Caminiti L, Ruggeri P, De Luca R, Vita D, La Rosa M, et al. Oral immunotherapy for cow's milk allergy with a weekly up-dosing regimen: a randomized single-blind controlled study. Ann Allergy Asthma Immunol. 2010; 105:376–381.

11. Martorell A, De la, Ibanez MD, Bone J, Terrados MS, Michavila A, et al. Oral desensitization as a useful treatment in 2-year-old children with cow's milk allergy. Clin Exp Allergy. 2011; 41:1297–1304.

12. Salmivesi S, Korppi M, Makela MJ, Paassilta M. Milk oral immunotherapy is effective in school-aged children. Acta Paediatr. 2013; 102:172–176.

13. Buchanan AD, Green TD, Jones SM, Scurlock AM, Christie L, Althage KA, et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol. 2007; 119:199–205.

14. Itoh N, Itagaki Y, Kurihara K. Rush specific oral tolerance induction in school-age children with severe egg allergy: one year follow up. Allergol Int. 2010; 59:43–51.

15. Vickery BP, Pons L, Kulis M, Steele P, Jones SM, Burks AW. Individualized IgE-based dosing of egg oral immunotherapy and the development of tolerance. Ann Allergy Asthma Immunol. 2010; 105:444–450.

16. Garcia Rodriguez R, Urra JM, Feo-Brito F, Galindo PA, Borja J, Gomez E, et al. Oral rush desensitization to egg: efficacy and safety. Clin Exp Allergy. 2011; 41:1289–1296.

17. Burks AW, Jones SM, Wood RA, Fleischer DM, Sicherer SH, Lindblad RW, et al. Oral immunotherapy for treatment of egg allergy in children. N Engl J Med. 2012; 367:233–243.

18. Meglio P, Giampietro PG, Carello R, Gabriele I, Avitabile S, Galli E. Oral food desensitization in children with IgE-mediated hen's egg allergy: a new protocol with raw hen's egg. Pediatr Allergy Immunol. 2013; 24:75–83.

19. Dello Iacono I, Tripodi S, Calvani M, Panetta V, Verga MC, Miceli Sopo S. Specific oral tolerance induction with raw hen's egg in children with very severe egg allergy: a randomized controlled trial. Pediatr Allergy Immunol. 2013; 24:66–74.

20. Clark AT, Islam S, King Y, Deighton J, Anagnostou K, Ewan PW. Successful oral tolerance induction in severe peanut allergy. Allergy. 2009; 64:1218–1220.

21. Jones SM, Pons L, Roberts JL, Scurlock AM, Perry TT, Kulis M, et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol. 2009; 124:292–300.

22. Blumchen K, Ulbricht H, Staden U, Dobberstein K, Beschorner J, de Oliveira LC, et al. Oral peanut immunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol. 2010; 126:83–91.

23. Varshney P, Jones SM, Scurlock AM, Perry TT, Kemper A, Steele P, et al. A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol. 2011; 127:654–660.

24. Meglio P, Bartone E, Plantamura M, Arabito E, Giampietro PG. A protocol for oral desensitization in children with IgE-mediated cow's milk allergy. Allergy. 2004; 59:980–987.

25. Keet CA, Frischmeyer-Guerrerio PA, Thyagarajan A, Schroeder JT, Hamilton RG, Boden S, et al. The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol. 2012; 129:448–455.

26. Vickery BP, Scurlock AM, Kulis M, Steele PH, Kamilaris J, Berglund JP, et al. Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy. J Allergy Clin Immunol. 2014; 133:468–475.

27. Tang ML, Martino DJ. Oral immunotherapy and tolerance induction in childhood. Pediatr Allergy Immunol. 2013; 24:512–520.

28. Khoriaty E, Umetsu DT. Oral immunotherapy for food allergy: towards a new horizon. Allergy Asthma Immunol Res. 2013; 5:3–15.

29. Wells HG, Osborne TB. The biological reactions of the vegetable proteins. I. Anaphylaxis. J Infect Dis. 1911; 8:66–124.

30. Friedman A, Weiner HL. Induction of anergy or active suppression following oral tolerance is determined by antigen dosage. Proc Natl Acad Sci U S A. 1994; 91:6688–6692.

31. Chen Y, Inobe J, Marks R, Gonnella P, Kuchroo VK, Weiner HL. Peripheral deletion of antigen-reactive T cells in oral tolerance. Nature. 1995; 376:177–180.

32. Chen Y, Kuchroo VK, Inobe J, Hafler DA, Weiner HL. Regulatory T cell clones induced by oral tolerance: suppression of autoimmune encephalomyelitis. Science. 1994; 265:1237–1240.

33. Curotto de, Kutchukhidze N, Shen S, Ding Y, Yee H, Lafaille JJ. Adaptive Foxp3+ regulatory T cell-dependent and -independent control of allergic inflammation. Immunity. 2008; 29:114–126.

34. Plaut M, Sawyer RT, Fenton MJ. Summary of the 2008 National Institute of Allergy and Infectious Diseases-US Food and Drug Administration Workshop on Food Allergy Clinical Trial Design. J Allergy Clin Immunol. 2009; 124:671–678.e1.

35. Eriksson NE, Möller C, Werner S, Magnusson J, Bengtsson U, Zolubas M. Self-reported food hypersensitivity in Sweden, Denmark, Estonia, Lithuania, and Russia. J Investig Allergol Clin Immunol. 2004; 14:70–79.

36. Gamboa PM, Cáceres O, Antepara I, Sanchez-Monge R, Ahrazem O, Salcedo G, et al. Two different profiles of peach allergy in the north of Spain. Allergy. 2007; 62:408–414.

37. Thyagarajan A, Varshney P, Jones SM, Sicherer S, Wood R, Vickery BP, et al. Peanut oral immunotherapy is not ready for clinical use. J Allergy Clin Immunol. 2010; 126:31–32.

38. Fisher HR, du Toit G, Lack G. Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance?: a meta-analysis of published RCTs. Arch Dis Child. 2011; 96:259–264.

39. Brozek JL, Terracciano L, Hsu J, Kreis J, Compalati E, Santesso N, et al. Oral immunotherapy for IgE-mediated cow's milk allergy: a systematic review and meta-analysis. Clin Exp Allergy. 2012; 42:363–374.

40. Nurmatov U, Venderbosch I, Devereux G, Simons FE, Sheikh A. Allergen-specific oral immunotherapy for peanut allergy. Cochrane Database Syst Rev. 2012; 9:CD009014.

41. Yeung JP, Kloda LA, McDevitt J, Ben-Shoshan M, Alizadehfar R. Oral immunotherapy for milk allergy. Cochrane Database Syst Rev. 2012; 11:CD009542.

42. Alvaro M, Giner MT, Vázquez M, Lozano J, Domínguez O, Piquer M, et al. Specific oral desensitization in children with IgE-mediated cow's milk allergy Evolution in one year. Eur J Pediatr. 2012; 171:1389–1395.

43. Pajno GB, Caminiti L, Salzano G, Crisafulli G, Aversa T, Messina MF, et al. Comparison between two maintenance feeding regimens after successful cow's milk oral desensitization. Pediatr Allergy Immunol. 2013; 24:376–381.

44. Sudo K, Taniuchi S, Takahashi M, Soejima K, Hatano Y, Nakano K, et al. Home-based oral immunotherapy (OIT) with an intermittent loading protocol in children unlikely to outgrow egg allergy. Allergy Asthma Clin Immunol. 2014; 10:11.

45. Passalacqua G, Landi M, Pajno GB. Oral immunotherapy for cow's milk allergy. Curr Opin Allergy Clin Immunol. 2012; 12:271–277.

46. Hofmann AM, Scurlock AM, Jones SM, Palmer KP, Lokhnygina Y, Steele PH, et al. Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol. 2009; 124:286–291.