Immunotherapy
Allergen-Specific Immunotherapy
Food allergen-specific immunotherapy, mainly used for the treatment of IgE-mediated allergies, aims to re-train the immune system's response to specific allergens. This method involves controlled exposure to small amounts of the allergen, gradually increasing the dose over time to achieve desensitization. Through desensitization, the immune system learns to tolerate the allergen without triggering an allergic reaction. Immunotherapy can be administered orally, sublingually, or through epicutaneous patches. Oral immunotherapy (OIT) is the most commonly used form of immunotherapy. Studies have mainly demonstrated the efficacy of OIT in desensitizing children allergic to milk, eggs and peanuts, although this method has also been used for managing reactions to other allergens, including wheat, tree nuts and shellfish. Two studies assessing OIT for tree nut allergies showed promising results. One evaluated walnut OIT in 55 children, of which 49 (89%) achieved…
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Allergen-Specific Immunotherapy
Food allergen-specific immunotherapy, mainly used for the treatment of IgE-mediated allergies, aims to re-train the immune system's response to specific allergens. This method involves controlled exposure to small amounts of the allergen, gradually increasing the dose over time to achieve desensitization. Through desensitization, the immune system learns to tolerate the allergen without triggering an allergic reaction. Immunotherapy can be administered orally, sublingually, or through epicutaneous patches. Oral immunotherapy (OIT) is the most commonly used form of immunotherapy. Studies have mainly demonstrated the efficacy of OIT in desensitizing children allergic to milk, eggs and peanuts, although this method has also been used for managing reactions to other allergens, including wheat, tree nuts and shellfish. Two studies assessing OIT for tree nut allergies showed promising results. One evaluated walnut OIT in 55 children, of which 49 (89%) achieved desensitization. The treatment also induced desensitization to pecan and cashew nuts. The other study recruited 50 children to evaluate cashew OIT, demonstrating cashew desensitization in 44/50 (88%) of participants and inducing desensitization to pistachios in all pistachio-allergic children (35/35). Additional studies provided valuable insights into wheat and sesame OIT in children, revealing promising desensitization rates.
While immunotherapy holds promise in managing food allergies, it is crucial to acknowledge its limitations. Allergic reactions remain a potential risk throughout the treatment process, requiring careful monitoring and medical intervention. Studies show that patients receiving OIT experience a higher frequency of both local and systemic reaction compared to those who are not receiving OIT. Moreover, the treatment often necessitates prolonged duration, with the allergen doses during treatment gradually increasing over the course of 3 to 9 months until a daily maintenance dose is reached. Even then, the maintenance dose must be sustained over months to years to enable a patient to ingest a few grams of the allergen without experiencing clinical issues.
References
- Anvari S, Miller J, Yeh CY, Davis CM. IgE-Mediated Food Allergy. Clinic Rev Allerg Immunol. 2019;57(2):244-260.
- Burks AW, Sampson HA, Plaut M, Lack G, Akdis CA. Treatment for food allergy. J Allergy Clin Immunol. 2018;141(1):1-9.
- Elizur A, Appel MY, Nachshon L, et al. Cashew oral immunotherapy for desensitizing cashew-pistachio allergy (NUT CRACKER study). Allergy. 2022;77(6):1863–1872.
- Elizur A, Appel MY, Nachshon L, et al. Walnut oral immunotherapy for desensitisation of walnut and additional tree nut allergies (Nut CRACKER): a single-centre, prospective cohort study. Lancet Child Adolesc Health. 2019;3(5):312-321.
- Elizur A, Appel MY, Nachshon L, et al. Walnut oral immunotherapy for desensitisation of walnut and additional tree nut allergies (Nut CRACKER): a single-centre, prospective cohort study. Lancet Child Adolesc Health. 2019;3(5):312-321.
- Fu L, Cherayil BJ, Shi H, et al. Overview of the Immunology of Food Allergy Food. Fu L, Cherayil BJ, Shi H, et al, eds. In: Food Allergy From Molecular Mechanisms to Control Strategies. Springer Nature Singapore; 2019:1-12.
- Nachshon L, Goldberg MR, Levy MB, et al. Efficacy and Safety of Sesame Oral Immunotherapy—A Real-World, Single-Center Study. J Allergy Clin Immunol: In Practice. 2019;7(8):2775-2781.e2.
- Nowak-Węgrzyn A, Wood RA, Nadeau KC, et al. Multicenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy. J Allergy Clin Immunol. 2019;143(2):651-661.e9.
- Nurmatov U, Dhami S, Arasi S, et al. Allergen immunotherapy for IgE‐mediated food allergy: a systematic review and meta‐analysis. Allergy. 2017;72(8):1133-1147.
- Pouessel G, Lezmi G. Oral immunotherapy for food allergy: Translation from studies to clinical practice? World Allergy Organ J. 2023;16(2):100747.
- Pouessel G, Lezmi G. Oral immunotherapy for food allergy: Translation from studies to clinical practice? World Allergy Organ J. 2023;16(2):100747.
