Diagnosis, management, and investigational therapies for food allergies

Abstract

Food allergies have increased in prevalence over the past 20 years, now becoming an important public health concern. Although there are no therapies currently available for routine clinical care, recent reports have indicated that immunotherapies targeting the mucosal immune system may be effective. Oral immunotherapy is conducted by administering small, increasing amounts of food allergen; it has shown promise for desensitizing individuals with peanut, egg, or milk allergies. Sublingual immunotherapy also desensitizes allergic patients to foods-2 major studies have examined the effects of sublingual immunotherapy in subjects with peanut allergies. We review the complex nature of IgE-mediated food allergies and the therapies being evaluated in clinical trials. We focus on the diagnosis and management of food allergies and investigational therapies.

Keywords: Food Allergy; Oral Immunotherapy; Prevalence; Sublingual Immunotherapy.

Figure 1

Mechanisms associated with desensitization and tolerance after OIT. In patients with allergies, allergen-specific Th2 cells secrete IL4, IL5, and IL13, which induce production of sIgE. sIgE binds to mast cells and basophils via FcERI; future encounters with the allergen leads to degranulation and release of mediators that cause symptoms of allergy. In the desensitized state after OIT, patients can ingest large amounts of allergen without a reaction. Tolerance is achieved in some patients after long courses of OIT, when daily maintenance doses are stopped for several weeks or months. SPT, ________________.