Current Trend in Immunotherapy for Peanut Allergy

Abstract

Peanut allergy is a hypersensitivity reaction with symptoms varying from mild to severe anaphylaxis, tends to be lifelong and very few are able to outgrow this allergy. The prevalence of peanut allergy is highest among the Western countries and over the past decade, a 3.5 fold increase in prevalence of peanut allergy was reported among children in the United States. Increasing prevalence has also been observed among the Asian countries. As with other food allergies, peanut allergy reduces quality of life for the affected individuals and the social and economy burden of healthcare for peanut allergy is substantial. To date, there is no effective treatment for peanut allergy and disease management is by avoidance or relieve of symptoms via administration of epinephrine. Peanut allergy is a type-1 hypersensitivity reaction due to specific IgE production by activated T-helper type 2 (T_H2) cells. Studies on various immunotherapy routes such as oral immunotherapy (OIT), sublingual immunotherapy and epicutaneous immunotherapy trials using peanut have shown the ability to induce desensitisation, shifting the allergen-specific cytokine production away from a T_H2 respond. In the recent years, lactic acid bacteria probiotics have been reported to down-regulate allergy due to its inherent immunomodulatory properties. Wild-type probiotic in combination with peanut proteins or recombinant probiotics harbouring peanut allergens have been explored for OIT due to its ability to down-regulate allergen-specific-IgE production and the T_H2 responses, while increasing the beneficiary population of T_H1 regulatory T cells (T_reg). This review discusses the current strategies in immunotherapy for peanut allergy.

Keywords:

• Peanut
• peanut allergy
• oral immunotherapy
• probiotic
• treatment

Acknowledgements

Chong Joo Chan wrote the original manuscript, Timmy Richardo contributed to the write-up on mucosal immunity, design of the figures and formatted the manuscript. Renee Lay Hong Lim revises and edited the manuscript. All authors read and approved the final manuscript.

Conflict of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

This review article was supported by the Fundamental Research Grant Scheme under Grant FRGS/2/2014/SG05/UCSI/02/1.