Oral and sublingual immunotherapy for food allergy: current progress and future directions

Abstract

Food allergies are increasing in prevalence and present an emerging epidemic for westernized countries. Strict dietary avoidance is the only approved management for food allergy, but accidental exposures regularly occur, leading to significant patient anxiety and decreased quality of life. Over the past decade, oral and sublingual immunotherapies have emerged as potential treatments for food allergy. While several small clinical trials have demonstrated that immunotherapy can desensitize food-allergic individuals, strategies for further enhancing safety and definitively establishing long-term efficacy are needed. This review presents an overview of recent oral and sublingual immunotherapy trials, and provides a glimpse into what the next generation of food immunotherapy may entail.

Figure 1

Strategies for improving food immunotherapy. Modification of food allergens to reduce recognition by IgE can be accomplished by extensive heating or molecular alteration of immunodominant epitopes. Incorporation of food allergens into nanoparticles or epicutaneous delivery of antigen could improve immunotherapy efficacy while reducing treatment-associated adverse reactions. Finally, adjunct use of immunomodulatory agents may prevent allergic responses mediated by allergen-specific T helper (T_H) cells, and promote tolerance through induction of T cell anergy or development of regulatory T cells.