Oral immunotherapy for food allergy

Abstract

Food allergy is a pathological, potentially deadly cascade of immune responses to molecules or molecular fragments that are normally innocuous when encountered in foods, such as milk, egg, or peanut. As the incidence and prevalence of food allergy rise, the standard of care is poised to advance beyond food allergen avoidance coupled with injectable epinephrine treatment of allergen-induced systemic reactions. Recent studies provide evidence that oral immunotherapy may effectively redirect the atopic immune responses of food allergy patients as they ingest small but gradually increasing allergen doses over many months, eliciting safer immune responses to these antigens. Research into the molecular and cellular bases of pathological and therapeutic immune responses, and into the possibilities for their safe and effective modulation, is generating tremendous interest in basic and clinical immunology. We synthesize developments, innovations, and key challenges in our understanding of the immune mechanisms associated with atopy and oral immunotherapy for food allergy.

Keywords: Antigen-specific; Epitope; Oral food challenge; Sustained unresponsiveness; T helper 2 cell; Tolerogenic.

Fig. 1

Example food allergen OIT study design.

Fig. 2

Immune cell types and cytokines involved in healthy tolerance to food antigens. SFB: segmented, filamentous bacteria.

Fig. 3

T helper 2 cell-mediated atopic response to food antigens.

Fig. 4

Immune cell types and cytokines involved in desensitization to food antigens.

Fig. 5

Percentages of peanut-specific CD4⁺ T cells expressing IL-4 in each participant group (p value determined by Kruskal–Wallis test).