Current Insights into Immunotherapy Approaches for Food Allergy

Abstract

In the last decade, there has been increasing research dedicated to food immunotherapy to induce clinical desensitization and provide protection by increasing clinical reaction thresholds. Results from recent food immunotherapy studies with differing routes of administration (oral, sublingual, and epicutaneous) suggest that food immunotherapy can induce clinical desensitization with varying levels of safety, however lasting tolerance has not been demonstrated. Furthermore, treatment side effects and dosing logistics may make the therapies difficult for some supporting the need for alternative treatment approaches. Peptide immunotherapy and DNA vaccine approaches should in theory allow for safer administration by decreasing allergenicity but proof of their clinical efficacy and immunogenicity remains to be proven. Biologic agents may allow for increased safety and rapid up-dosing of immunotherapy with the added benefit of treating multiple allergens simultaneously.

Keywords:

• food allergy
• oral immunotherapy
• sublingual immunotherapy
• epicutaneous immunotherapy
• omalizumab
• dupilumab

Abbreviations

AE, adverse events; CoFAR, Consortium for Food Allergy Research; DBPCFC, double-blind placebo-controlled food challenge; EPIT, epicutaneous immunotherapy; IgE, immunoglobulin E; IgG4, immunoglobulin G4; OFC, oral food challenge; OIT, oral immunotherapy; QOL, quality of life; RCT, randomized controlled trial; SCD, successfully consumed dose; SLIT, sublingual immunotherapy; SU, sustained unresponsiveness.

Disclosure

JD Macdougall reports no conflicts of interest in this work. AW Burks reports being a minority stock holder in Allertein, Mastcell pharmaceuticals; scientific advisory board membership with Aimmune Therapeutics, Consortia TX Inc, Prota therapeutics; consultancy for Astella Pharma Global Development, DBV technologies, N-fold LLC, kaleo, Ukko Inc; royalties with UpToDate; and receives grant support to his institution from the NIH/NIAID, NIH/NCCIH, FARE and the Wallace Research Foundation. In addition, AW Burks has patents US 7,879,977, US 6,835,824, US 6,486,311, US 6,441,142, US 5,973,121, and US 5,558,869 issued. EH Kim reports clinical medical advisory board membership with DBV Technologies; consultancy with Aimmune Therapeutics, DBV Technologies, AllerGenis, Allakos, Kenota Health, Ukko, and Vibrant America; and receives grant support to his institution from the National Institute of Allergy and Infectious Diseases (NIH/NIAID), National Center for Complementary and Integrative Health (NIH/NCCIH), FARE and the Wallace Research Foundation. The authors report no other conflicts of interest in this work.