Sublingual Immunotherapy for Food Allergy and its Future Directions

Abstract

Food allergy is an important medical problem with increasing prevalence throughout the world. Different approaches of food immunotherapy are being investigated including oral, epicutaneous and sublingual routes. Sublingual immunotherapy (SLIT) for food allergy involves placement of glycerinated allergen under the tongue daily to achieve allergen-specific desensitization. SLIT has been studied in the treatment of hazelnut, peach, apple, milk and peanut allergies with substantial focus on the treatment of peanut allergy. Phase II studies have shown SLIT for treatment of peanut allergy increases the tolerated dose of peanut by a substantial margin with fewer and less severe side effects than other modalities. This review discusses the mechanisms of SLIT, early studies of its use in food allergy and larger randomized controlled trials for treatment of peanut allergy. Future directions using the mechanisms involved in SLIT include oral mucosal immunotherapy for peanut allergy.

Keywords::

• desensitization
• food allergy
• peanut allergy
• sublingual immunotherapy

Author contributions

SA Schworer and EH Kim reviewed the literature and wrote the paper.

Acknowledgments

Personal communication approved by E Berglund.

Financial & competing interests disclosure

EH Kim reports clinical medical advisory board membership with DBV Technologies; consultancy with Aimmune Therapeutics, DBV Technologies, AllerGenis, Allakos, 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 have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

EH Kim reports clinical medical advisory board membership with DBV Technologies; consultancy with Aimmune Therapeutics, DBV Technologies, AllerGenis, Allakos, 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 have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.