Food allergy immunotherapy

 

IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor. The content of the information articles and all illustrations on this website remains the intellectual property of Dr Raymond Mullins and cannot be reproduced without written permission.

Summary
Immunotherapy (“desensitisation”) to switch off food allergy is an active area of research, but is not yet ready for routine clinical practice. A number of small human studies have been published in the last 5 years, attempting to switch of allergy to dairy, egg and peanut by introducing small amounts of food, and increasing the dose over time.


These are hospital based trials for safety reasons, as many on these studies will have allergic reactions as the dose is being increased, some drop out due to side-effects, and others will have unexpected allergic reactions, such as if they eat the allergic food and then exercise, or have an infection, or forget to take their dose for a few days. There were also several reports of eosinophilic oesophagitis developing during food immunotherapy at the American Academy of Allergy, Asthma and Immunology meeting in San Francisco in 2011. Doses are increased under medical supervision, usually in hospital based specialist allergy units, with ongoing daily food allergen consumption between visits. While there have been reports of office or home based trials, these are not recommended for safety reasons.


This is an exciting area of research but hospital based nature of the studies (for safety reasons) precludes our ability to incorporate this into routine clinical practice. Indeed, one could fill up every hospital bed in Australia tomorrow with the large number of food allergic people we have in Australia at tis time. Long term, one needs a safe process that can be done as an outpatient. Time will tell.


References

Varshney P et al. A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol.  2011 Mar;127(3):654-60.


Kim EH et al. Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol. 2011 Mar;127(3):640-6.


Nowak-Węgrzyn A, Sampson HA. Future therapies for food allergies. J Allergy Clin Immunol. 2011 Mar;127(3):558-73


Kaneko H et al.Efficacy of the slow dose-up method for specific oral tolerance induction in children with cow's milk allergy: comparison with reported protocols. J Investig Allergol Clin Immunol. 2010;20(6):538-9.


Ojeda P, Ojeda I, Pineda F, Alfaya T, Ojeda JA. Induction of oral tolerance to peanut: a successful home-based protocol. J Investig Allergol Clin Immunol.2010;20(6):524-8.


Ridolo E, De Angelis GL, Dall'aglio P. Eosinophilic esophagitis after specific oral tolerance induction for egg protein. Ann Allergy Asthma Immunol. 2011 Jan;106(1):73-4.


Kulis M, Vickery BP, Burks AW. Pioneering immunotherapy for food allergy: clinical outcomes and modulation of the immune response. Immunol Res. 2011 Apr;49(1-3):216-26.


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 Dec;105(6):444-50.


Pajno GB 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 Nov;105(5):376-81.


Wasserman RL, Sugerman RW, Mireku-Akomeah N, Mansfield L, Baker JW. Office-based oral immunotherapy for food allergy is safe and effective. J Allergy Clin Immunol. 2011 Jan;127(1):290-1; author reply 291-2.


Katz Y, Goldberg MR, Stein M, Levy M. Oral immunotherapy: ready for prime time? J Allergy Clin Immunol. 2011 Jan;127(1):289-90; author reply 291-2.


Scurlock AM, Jones SM. An update on immunotherapy for food allergy. Curr Opin Allergy Clin Immunol. 2010 Dec;10(6):587-93.


Thyagarajan A et al. Peanut oral immunotherapy is not ready for clinical use. J Allergy Clin Immunol. 2010 Jul;126(1):31-2.


Blumchen K et al. Oral peanutimmunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol. 2010 Jul;126(1):83-91.


Sheikh A, Venderbosch I, Nurmatov U. Oral immunotherapy for peanut allergy. BMJ. 2010 Jun 3;340:c2938. doi: 10.1136/bmj.c2938.


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 Mar;96(3):259-64

Last reviewed April 2011