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Investigational therapies for food allergy: Oral immunotherapy

Anna Nowak-Węgrzyn, MD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


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. Oral immunotherapy (OIT) is one of several allergen-specific approaches 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.

OIT for food allergy is reviewed in this topic. Other food allergen-specific therapies as well as nonspecific therapies are reviewed separately. (See "Investigational therapies for food allergy: Immunotherapy and nonspecific therapies".)


OIT to food is generating increasing interest as a potential approach to the treatment of food allergy [7-10]. A high rate of desensitization has been demonstrated in both randomized trials and observational studies of OIT. Fewer treated patients become tolerant, but the rate of acquisition of tolerance is higher than that seen in patients who completely avoid the allergen. Additional long-term follow-up data are needed to help determine which patients will gain the most from OIT and in which patients the risks outweigh the benefits.

Rationale and mechanisms of action — The rationale for using the oral route is that ingestion of a food antigen preferentially results in an active immune system response but one that does not trigger an allergic reaction towards that antigen (ie, oral tolerance) [11,12]. Oral tolerance is thought to be mediated by induction of regulatory T cells with low-dose antigen exposure or lymphocyte anergy or deletion with high antigen doses. (See "Pathogenesis of food allergy", section on 'Factors influencing sensitization or tolerance'.)

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Literature review current through: Nov 2017. | This topic last updated: Aug 28, 2017.
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