Investigational therapies for food allergy: Immunotherapy 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 ultimate goal of therapy 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".)
GOALS OF TREATMENT FOR FOOD ALLERGY
The primary goal of treatment for food allergy is to induce permanent tolerance to the food, which means that there is no recurrence of clinical reactivity upon reintroduction of the food after a period of abstinence.
Important goals for patients and their families are reduction of anxiety related to food allergies and improvement in quality of life due to removal of dietary restrictions. These goals may be accomplished even if the patient does not develop permanent tolerance but rather a temporary state of desensitization or protection.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GOALS OF TREATMENT FOR FOOD ALLERGY
- FOOD ALLERGEN-SPECIFIC THERAPY
- Sublingual immunotherapy
- Epicutaneous immunotherapy
- Subcutaneous immunotherapy
- - Chemically modified, alum-adsorbed immunotherapy
- - Peptide immunotherapy
- Intradermal/intramuscular immunotherapy with LAMP-DNA vaccines
- Immunotherapy with modified proteins and adjuvants
- - Rectal immunotherapy with heat-killed bacteria and modified protein
- - Intradermal immunotherapy with immunostimulatory sequences
- NONSPECIFIC THERAPY
- Traditional Chinese medicine
- Food allergen-specific therapy
- Nonspecific therapy