Investigational therapies for food allergy: SLIT, EPIT, SCIT, and nonspecific therapies
- Anna Nowak-Węgrzyn, MD
Anna Nowak-Węgrzyn, MD
- Associate Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
Food allergy encompasses a variety of immune-mediated adverse reactions to foods that occur in genetically predisposed individuals [1,2]. Management of food allergy consists of strict avoidance of the food allergen and treatment of accidental exposures with medications. Allergies to certain foods, such as egg and milk, tend to be outgrown during childhood, whereas allergies to other foods, such as shellfish and nuts, are much more likely to persist. Several approaches are under investigation for the treatment of food allergy. (See "Management of food allergy: Avoidance" and "Food-induced anaphylaxis" and "Anaphylaxis: Emergency treatment".)
Novel therapeutic approaches to food allergy can be classified as food allergen specific (eg, immunotherapy with native or modified recombinant allergens, or oral desensitization) or food allergen nonspecific (eg, anti-immunoglobulin E [IgE], traditional Chinese medicine [TCM]) (table 1) [3-6]. The goal of these therapies is to induce permanent tolerance to the food, where the allergy will not recur upon re-exposure after a period of abstinence. However, some therapies in development appear to only temporarily desensitize or protect patients, requiring continued treatment to maintain efficacy. Before these new approaches are applied in clinical practice, they must be carefully evaluated for side effects, such as acute adverse reactions, toxicity, and overstimulation of T helper type 1 (Th1) immune responses that could prime for autoimmunity.
Oral immunotherapy (OIT) for food allergy is reviewed separately. Other food-specific therapies, as well as nonspecific therapies, are reviewed here. (See "Investigational therapies for food allergy: Oral immunotherapy".)
FOOD ALLERGEN-SPECIFIC THERAPY
The aim of allergen-specific therapies is to alter the allergic response to the food allergen so that the patient becomes desensitized or, preferably, tolerant to the specific food. Possible future food allergen-specific therapies include oral, sublingual, and subcutaneous immunotherapy. Allergens used for subcutaneous immunotherapy have been modified to retain immunogenicity but decrease allergenicity.
Sublingual immunotherapy — Another approach to food immunotherapy is sublingual immunotherapy (SLIT) with food extracts. There are few effector cells, such as mast cells, in the sublingual mucosa . Allergen extracts given sublingually are not systemically absorbed. Rather, they are taken up by dendritic cells in the mucosa and presented to T cells in the draining lymph nodes. Likely mechanisms of action include downregulation of mast cells and activation of T regulatory cells. SLIT has been attempted for peanut, hazelnut, cow's milk (CM), and kiwi allergies.
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- FOOD ALLERGEN-SPECIFIC THERAPY
- Sublingual immunotherapy
- Epicutaneous immunotherapy
- Subcutaneous immunotherapy
- - Peptide immunotherapy
- - Engineered recombinant protein immunotherapy
- - Immunomodulatory adjuvants
- NONSPECIFIC THERAPY
- Humanized monoclonal anti-IgE
- Traditional Chinese medicine
- Blockade of vasoactive mediators
- Food allergen-specific therapy
- Nonspecific therapy