Immunotherapy For Food Allergy Research Articles

Metabolomics of IgE-Mediated Food Allergy and Oral Immunotherapy Outcomes based on Metabolomic Profiling.

The immunometabolic mechanisms underlying variable responses to oral immunotherapy (OIT) in patients with IgE-mediated food allergy are unknown. To identify novel pathways associated with tolerance in food allergy, we used metabolomic profiling to find pathways important for food allergy in multi-ethnic cohorts and responses to OIT. Untargeted plasma metabolomics data were generated from the VDAART healthy infant cohort (N=384), a Costa Rican cohort of children with asthma (N=1040), and a peanut OIT trial (N=20) evaluating sustained unresponsiveness (SU, protection that lasts after therapy) versus transient desensitization (TD, protection that ends immediately afterwards). Generalized linear regression modeling and pathway enrichment analysis identified metabolites associated with food allergy and OIT outcomes. Compared with unaffected children, those with food allergy were more likely to have metabolomic profiles with altered histidines and increased bile acids. Eicosanoids (e.g., arachidonic acid derivatives) (q=2.4×10 -20 ) and linoleic acid derivatives (q=3.8×10 -5 ) pathways decreased over time on OIT. Comparing SU versus TD revealed differing concentrations of bile acids (q=4.1×10 -8 ), eicosanoids (q=7.9×10 -7 ), and histidine pathways (q=0.015). In particular, the bile acid lithocholate (4.97[1.93,16.14], p=0.0027), the eicosanoid leukotriene B4 (3.21[1.38,8.38], p=0.01), and the histidine metabolite urocanic acid (22.13[3.98,194.67], p=0.0015) were higher in SU. We observed distinct profiles of bile acids, histidines, and eicosanoids that vary among patients with food allergy, over time on OIT and between SU and TD. Participants with SU had higher levels of metabolites such as lithocholate and urocanic acid, which have immunomodulatory roles in key T-cell subsets, suggesting potential mechanisms of tolerance in immunotherapy. - Compared with unaffected controls, children with food allergy demonstrated higher levels of bile acids and distinct histidine/urocanic acid profiles, suggesting a potential role of these metabolites in food allergy. - In participants receiving oral immunotherapy for food allergy, those who were able to maintain tolerance-even after stopping therapyhad lower overall levels of bile acid and histidine metabolites, with the exception of lithocholic acid and urocanic acid, two metabolites that have roles in T cell differentiation that may increase the likelihood of remission in immunotherapy. This is the first study of plasma metabolomic profiles of responses to OIT in individuals with IgE-mediated food allergy. Identification of immunomodulatory metabolites in allergic tolerance may help identify mechanisms of tolerance and guide future therapeutic development.

Immunotherapies for food allergy: Exploring new targets and innovative strategies for enhanced efficacy

Food allergy is a growing public health concern. It affects children and adults, resulting in significant declines in the overall quality of life. In most cases, individuals must avoid consuming allergenic foods, which can be challenging, especially for patients who experience life-threatening symptoms even with minimal exposure to allergens. This review aimed to identify promising targets for immunotherapy in food allergy, strategies to reduce adverse reactions and side effects, optimal dosing approaches, clinical endpoints to measure efficacy, patient subgroups that benefit, and barriers to implementing immunotherapy. An in-depth literature review was conducted using PubMed and Google Scholar to look into novel approaches and possible targets for enhancing the effectiveness of immunotherapy. Targeting specific immune cells and molecules (e.g., IgE and Tregs), lowering the doses of allergens, extending intervals between doses, personalising dosing, selecting eligible patients carefully, and validating clinical endpoints have shown promising results in overcoming food allergy challenges and increasing immunotherapy efficacy. Potential innovative strategies to enhance immunotherapy efficacy encompass developing more cost-effective approaches, increasing access to trained specialists, developing standardised protocols, and collecting long-term data.

Challenges of oral immunotherapy for food allergy during a national crisis

Challenges of oral immunotherapy for food allergy during a national crisis

Age-Related Food Aversion and Anxiety Represent Primary Patient Barriers to Food Oral Immunotherapy

BackgroundWhile oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure’s implementation have not been extensively evaluated from a patient perspective ObjectiveWe evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and evaluated the role of healthcare professionals, especially dietitians MethodsA survey in Canada and the US involved families currently enrolled in food OIT programmes ResultsOf responses from 379 participants, fear of reaction was the most common barrier to OIT initiation, with 45.6% reporting it being a “very significant” barrier with other fears reported. However, taste aversion represented the prominent obstacle to continuation. Taste aversion was associated with slower buildup (p=0.02), and reduction in dose (p=0.002). Taste aversion was a strongly age-dependent barrier for initiation (p<0.001) and continuation (p<0.002), with older children over 6 years of age reporting it as a very significant barrier (p<0.001). Boredom was reported as a concern for specific allergens such as peanut, egg, sesame, and hazelnuts (p<0.05), emphasizing the need for diverse food options. Notably, 59.9% of respondents mixed OIT foods with sweet items. Despite these dietary concerns, dietitians were underutilized, with only 9.5% of respondents having seen a dietitian and the majority finding dietitian support helpful with greater certainty about the exact dose (p<0.001) ConclusionsTaste aversion and anxiety represent primary patient-related barriers to OIT. Taste aversion was highly age-dependent, with older patients being more affected. Dietitians and psychology support were underutilized, representing a critical target to improve adherence and OIT success

Transcriptomic changes associated with oral immunotherapy for food allergy.

This review summarizes recent advances in characterizing the transcriptional pathways associated with outcomes following Oral Immunotherapy. Recent technological advances including single-cell sequencing are transforming the ways in which the transcriptional landscape is understood. The application of these technologies is still in its infancy in food allergy but here we summarize current understanding of gene expression changes following oral immunotherapy for food allergy and specific signatures underpinning the different clinical outcomes of desensitization and remission (sustained unresponsiveness). T helper 2A cells have been identified as a cell type which correlates with disease activity and is modified by treatment. Molecular features at study entry may differentiate individuals who achieve more positive outcomes during OIT. Recent findings point to T cell anergy and Type 1 interferon pathways as potential mechanisms supporting redirection of the allergen-specific immune response away from allergy towards remission. Despite these developments in our understanding of immune mechanisms following OIT, there are still significant gaps. Additional studies examining immune signatures associated with long term and well-defined clinical outcomes are required to gain a more complete understanding of the pathways leading to remission of allergy, in order to optimize treatments and gain improved outcomes for patients.

Safety and Effectiveness of Bypassing Oral Immunotherapy Buildup With an Initial Phase of Sublingual Immunotherapy for Higher-Risk Food Allergy

Because of its favorable safety, sublingual immunotherapy (SLIT) for food allergy has been proposed as an alternative treatment for those in whom oral immunotherapy (OIT) is of higher risk-older children, adolescents, adults, and those with a history of severe reactions. Although safe, SLIT has been shown to be less effective than OIT. To describe the safety of multifood SLIT in pediatric patients aged 4 to 18 years and the effectiveness of bypassing OIT buildup with an initial phase of SLIT. Patients aged 4 to 18 years were offered (multi)food SLIT. Patients built up to 2 mg protein SLIT maintenance over the course of 3 to 5 visits under nurse supervision. After 1 to 2 years of daily SLIT maintenance, patients were offered a low-dose oral food challenge (OFC) (cumulative dose, 300 mg protein) with the goal of bypassing OIT buildup. Between summer 2020 and winter 2023, 188 patients were enrolled in SLIT (median age, 11 years). Four patients (2.10%) received epinephrine during buildup and went to the emergency department, but none experienced grade 4 (severe) reaction. A subset of 20 patients had 50 low-dose OFCs to 300 mg protein and 35 (70%) OFCs were successful, thereby bypassing OIT buildup. In combination with very favorable safety of SLIT, with no life-threatening reactions and few reactions requiring epinephrine, we propose that an initial phase of SLIT to bypass supervised OIT buildup be considered for children in whom OIT is considered to be of higher risk.

Efficacy of biological agents combined with oral immunotherapy (OIT) for food allergy: a protocol for a systematic review and meta-analysis

IntroductionFood allergy affects a large population throughout the world. Recently, oral immunotherapy (OIT) has been reported as an effective treatment for severe food allergy. Although OIT was successful in numerous...

Flex-IT! Applying “Platform Trials” Methodology to Immunotherapy for Food Allergy in Research and Clinical Practice

There is an increasing trend in the management of food allergy toward active treatment using allergen immunotherapy (AIT). Although AIT is efficacious, treatment-related adverse events are common, particularly with oral immunotherapy in those with high levels of allergen-specific IgE sensitization. In clinical practice, these adverse events inevitably create challenges: clinicians and patients routinely face decisions whether to alter the dose itself, the frequency of dosing, and the pace of escalation, or indeed discontinue AIT altogether. Flexibility is therefore needed to adapt treatment, particularly in clinical practice, so that participants are "treated-to-target." For example, this may entail a significant change in the dosing protocol or even switching from one route of administration to another in response to frequent adverse events. We refer to this approach as flexible immunotherapy. However, there is little evidence to inform clinicians as to what changes to treatment are most likely to result in treatment success. Classical clinical trials rely, by necessity, on relatively rigid updosing protocols. To provide an evidence base to optimize AIT, the food allergy community should adopt adaptive platform trials, where a "master protocol" facilitates more efficient evaluation, including longer-term outcomes of multiple interventions. Within a single clinical trial, participants are able to switch between different treatment arms; interventions can be added or dropped without compromising the integrity of the trial. Developing platform trials for food AIT may initially be costly, but they represent a significant opportunity to grow the evidence base (with respect to both treatment outcomes and biomarker discovery) at scale. In addition, they could help understand longitudinal disease trajectories that are difficult to study in clinical trials for food allergy due to the time needed to demonstrate changes in efficacy. Finally, their adoption would achieve greater collaboration and consistency in approaches to proactive management of food allergy in routine clinical practice. As a community, we need to actively pursue this with funders and established research collaborations to deliver the very best outcomes for our patients and their families.

Update in paediatric asthma, immunotherapy for food allergy, and high-flow

Update in paediatric asthma, immunotherapy for food allergy, and high-flow

Immunotherapy for food allergy: current proposals to improve safety and efficacy

Abstract This review mainly focuses on the novel approaches that improve the safety and efficacy of immunotherapies, namely SLIT [alone or as pre-treatment of oral immunotherapy (OIT)], epicutaneous immunotherapy (EPIT), combination of anti-IgE into OIT or sublingual immunotherapy (SLIT) and introduction of hypoallergenic allergens by modifying native food products (boiling, baking, etc.) or manufacturing recombinant proteins. Among these proposals, some are clinically proven safe such as the use of anti-IgE while some are still under preclinical trials such as the use of some newly developed recombinant food protein allergens. What is certain is that more preclinical and clinical reviews and trials would be required on all these proposals before they could be maturely, safely, and effectively promoted in the clinical settings for patients’ use.

Application of biologicals in patients with food allergies

Despite promising advancements in oral immunotherapy for food allergies, medical implementation faces limitations. Non-specific treatment options based on inhibiting the type 2 inflammatory pathway, including monoclonal antibodies, are under investigation. TNX-901 and omalizumab have demonstrated increased reaction thresholds, reducing adverse events in peanut-allergic patients. Dupilumab, blocking the IL-4 receptor, shows positive results in both food allergies and eosinophilic esophagitis. Antibodies against alarmins and anti-IL-5, such as etokimab and mepolizumab, have proven efficacy in preclinical studies and clinical trials. While further studies are needed to establish their practical clinical use and determine suitability for different types of food allergies, these monoclonal antibodies present a promising horizon for the treatment of such conditions.

Allergen Immunotherapy and/or Biologicals for IgE-mediated Food Allergy: A Systematic Review and Meta-analysis.

Allergen Immunotherapy and/or Biologicals for IgE-mediated Food Allergy: A Systematic Review and Meta-analysis.

Recent advances in epicutaneous immunotherapy and potential applications in food allergy.

Given the potent immunological properties of the skin, epicutaneous immunotherapy (EPIT) emerges as a promising treatment approach for inducing immune tolerance, particularly for food allergies. Targeting the highly immunocompetent, non-vascularized epidermis allows for the application of microgram amounts of allergen while significantly reducing the risk of allergen passage into the bloodstream, thus limiting systemic allergen exposure and distribution. This makes EPIT highly suitable for the treatment of potentially life-threatening allergies such as food allergies. Multiple approaches to EPIT are currently under investigation for the treatment of food allergy, and these include the use of allergen-coated microneedles, application of allergen on the skin pretreated by tape stripping, abrasion or laser-mediated microperforation, or the application of allergen on the intact skin using an occlusive epicutaneous system. To date, the most clinically advanced approach to EPIT is the Viaskin technology platform. Viaskin is an occlusive epicutaneous system (patch) containing dried native allergen extracts, without adjuvants, which relies on frequent application for the progressive passage of small amounts of allergen to the epidermis through occlusion of the intact skin. Numerous preclinical studies of Viaskin have demonstrated that this particular approach to EPIT can induce potent and long-lasting T-regulatory cells with broad homing capabilities, which can exert their suppressive effects in multiple organs and ameliorate immune responses from different routes of allergen exposure. Clinical trials of the Viaskin patch have studied the efficacy and safety for the treatment of life-threatening allergies in younger patients, at an age when allergic diseases start to occur. Moreover, this treatment approach is designed to provide a non-invasive therapy with no restrictions on daily activities. Taken together, the preclinical and clinical data on the use of EPIT support the continued investigation of this therapeutic approach to provide improved treatment options for patients with allergic disorders in the near future.

Food allergy: Trends in the development of allergen-specific immunotherapy technologies

BACKGROUND: Food allergy is an urgent problem for public health around the world. One of the most promising methods of food allergy treatment is allergen-specific immunotherapy.&#x0D; AIM: to analyze the results of clinical studies on the effectiveness and safety of modern allergen-specific immunotherapy technologies in the treatment of food allergies published over the past three years.&#x0D; MATERIALS AND METHODS: A search and analysis of scientific publications was carried out using resources cataloging biomedical scientific literature: PubMed and eLibrary. The review includes original studies published between January 1, 2020 and December 31, 2022.&#x0D; RESULTS: The review made it possible to systematize the data accumulated over the past three years, reflecting the main trends in allergen-specific immunotherapy of food allergy. The analysis of studies showed modern approaches to oral and epicutaneous immunotherapy and affected the efficacy and safety of these types of treatment. In food allergy cohorts, the allergen-specific immunotherapy approach of oral and epicutaneous allergen-specific immunotherapy has been shown to be highly effective in achieving tolerance and desensitization to the food trigger it was revealed that epicutaneous allergen-specific immunotherapy is characterized by a high level of adherence of patients to treatment.&#x0D; CONCLUSION: It is necessary to continue conducting large-scale clinical studies on modern methods of allergen-specific immunotherapy in patients with food allergies to form standardized therapy protocols.

New Approaches to Food Allergy Immunotherapy

Food allergy is an increasing public health problem in children and adults. In addition to the risk of potentially severe reactions, food allergy can have a significant burden on quality of life, nutrition, cost of living, and social activities. Traditionally, treatment has primarily included strict food allergen avoidance and use of emergency medications to treat an allergic reaction. However, in recent years, there have been significant strides in the advancement of food allergy treatment, including the approval of the first and only approved therapy (peanut oral immunotherapy) for food allergy in 2020. Clinical trials have primarily focused on food allergen immunotherapy (oral, epicutaneous, sublingual). Building off of a foundation of promising data supporting the efficacy of food oral immunotherapy and our greater understanding of the underlying mechanism of immunotherapy, newer approaches, including alternative routes of delivery, adjuncts to therapy, modified allergens, and utilization in younger patients, aim to provide safer and more effective treatment approaches to the millions of patients burdened by food allergy.

Preclinical evaluation of alternatives to oral immunotherapy for food allergies.

The increasing food allergy incidence has led to significant interest in developing therapies for allergic diseases. Oral allergen-specific immunotherapy (OIT) is a recently FDA-approved therapeutic to treat peanut allergies. OIT utilizes daily allergen dosing to reduce allergic reactions to peanuts. However, there is diminished enthusiasm for daily OIT, potentially due to the strict regimen required to induce desensitization and the risks of severe adverse events. Thus, there remains a need for safe and effective food allergy treatments that are well-received by allergic individuals. Preclinical research studies investigate methods to induce allergen desensitization in animals and support clinical studies that address the limitations of current food allergy OIT. Because allergic reactions are triggered by allergen doses above an individual's activation threshold, immunotherapy regimens that induce allergen desensitization with lower allergen doses or without the requirement of daily administrations may expand the use of food allergy immunotherapy. Administering allergen immunotherapy by alternative routes is a strategy to induce desensitization using lower allergen doses than OIT. Several animal models have evaluated oral, sublingual, epicutaneous, and intranasal immunotherapy routes to treat food allergies. Each immunotherapy route may require different allergen doses, formulations, and treatment schedules to induce desensitization. This article will discuss scientific findings from food allergy immunotherapy animal studies that utilize various immunotherapy routes to induce allergen desensitization to support future clinical studies that enhance the safety and efficacy of allergen immunotherapy to treat food allergies.

Severe Anaphylactic Reactions to Home Doses of Oral Immunotherapy for Food Allergy.

Severe anaphylactic reactions to home doses may occur during food allergy oral immunotherapy (OIT). To study the rate and risk factors for such reactions. We studied all patients aged greater than 3.5 years who completed OIT in a single center between April 2010 and January 2020. All home epinephrine-treated reactions (HETRs) were identified. High-grade HETRs (HG-HETRs) were defined as HETRs involving respiratory (SpO2 of 94% or less), cardiovascular (low blood pressure), or central nervous system impairment (loss of consciousness). We investigated the rate and risk factors for HG-HETRs. A total of 1,637 OIT treatments were studied: milk (880), peanut (346), tree nuts (221), sesame (115), and egg (75). Of 390 identified HETRs, 30 HG-HETRs occurred during 27 treatments (1.65% of all treatments). Nearly all (26 of 30) were during milk OIT in patients with house dust mite (HDM) sensitization and asthma (26 of 30 each). Of the 30 patients with HG-HETRs, 21 recovered with one or two epinephrine treatments, but nine (0.55% of all treatments) did not respond to a second dose of epinephrine and were deemed to have refractory anaphylaxis. Three patients required intensive care unit admission and three received epinephrine drip, but none required ventilatory support. Risk factors for HG-HETRs included milk OIT (P= .031), asthma (P= .02) and HDM sensitization (P= .02). No specific triggers for HG-HETR were identified. Of patients with HG-HETRs, 25.9% were fully desensitized, including the four non-milk treated patients; 22.2% were partially desensitized; and 51.9% failed. High-grade HETRs are uncommon, particularly refractory anaphylactic reactions to home OIT doses. Although milk OIT, asthma, and HDM sensitization are the main risk factors for such reactions, identification of patients who are at risk is challenging.

IgE Epitope Analysis and Hypo-Immunoreactivity Derivative of Arginine Kinase in Mantis Shrimp (Oratosquilla oratoria).

As the main allergenic food, shrimp can trigger allergic reactions in various degrees. In this study, arginine kinase (AK) was identified as an allergen in Oratosquilla oratoria by LC-MS/MS. The open reading frame of AK was obtained, which included 356 amino acids, and recombinant AK (rAK) was expressed in Escherichia coli. The results of immunological analysis and circular dichroism showed that rAK displayed similar IgG-/IgE-binding activity and structure as native AK. Besides, five IgE linear epitopes of AK were verified by serological analysis, on the basis of which an epitope-deleted derivative was obtained and named as mAK-L. It has been shown that mAK-L displayed hypo-immunoreactivity compared to rAK, and the contents of secondary structures were different. In conclusion, these discoveries enrich the overall understanding of crustacean allergens and epitopes and set the foundations for food allergy diagnosis and immunotherapy.

Editorial introductions.

Editorial introductions.

Mechanisms of desensitization with oral immunotherapy and epicutaneous immunotherapy.

Oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) are emerging therapies for food allergy. With several recently published exploratory trials and randomized controlled clinical trials that support these procedures, there is a clear progress and interest toward making these treatment options available for allergist/immunologists and patients with food allergies entrusted to their care. However, there still remain many questions and concerns to be addressed before these procedures can be fully understood. The purpose of the present report is to trace some of the important historical milestones in the development of OIT and EPIT that have contributed to their evolving clinical application to the treatment of food allergy, to describe some of the current understandings of the immunologic mechanisms by which these procedures elicit desensitization, and to provide some areas for future inquiry and research. An extensive research was conducted in the medical literature data bases by applying terms such as food allergy, desensitization, tolerance, unresponsiveness, Treg cells, allergen immunotherapy (AIT), oral immunotherapy (OIT), and epicutaneous immunotherapy (EPIT). OIT and EPIT take their origins from AIT (also called desensitization), a procedure first reported for the treatment of hay fever over a 100 years ago in which slowly increasing doses of a specifically relevant allergen were administered until a maintenance dosage was achieved when the patient was free of symptoms. OIT and EPIT differ from AIT in certain aspects including the route of administration of the allergen as well as their relative shorter period of sustained unresponsiveness. The origins and important historical landmarks that have been made in the field of food allergy immunotherapy are presented in the context of the immunologic mechanisms that contribute to the pathogenesis of these disorders. Although considerable progress has been made in recent years toward making these treatment options available for allergist/immunologists and patients with food allergies, there still remain many questions and concerns to be addressed before these procedures can be fully understood, which can be illuminated by future research.