Sublingual Immunotherapy For Food Allergy Research Articles

Sublingual immunotherapy for food allergy and its future directions.

Food allergy is an important medical problem with increasing prevalence throughout the world. Different approaches of food immunotherapy are being investigated including oral, epicutaneous and sublingual routes. Sublingual immunotherapy (SLIT) for food allergy involves placement of glycerinated allergen under the tongue daily to achieve allergen-specific desensitization. SLIT has been studied in the treatment of hazelnut, peach, apple, milk and peanut allergies with substantial focus on the treatment of peanut allergy. Phase II studies have shown SLIT for treatment of peanut allergy increases the tolerated dose of peanut by a substantial margin with fewer and less severe side effects than other modalities. This review discusses the mechanisms of SLIT, early studies of its use in food allergy and larger randomized controlled trials for treatment of peanut allergy. Future directions using the mechanisms involved in SLIT include oral mucosal immunotherapy for peanut allergy.

Oral and sublingual immunotherapy for food allergy.

To critically appraise the recent most relevant studies in the rapidly advancing field of food oral and sublingual immunotherapy. Food allergen-specific immunotherapy via oral (OIT) and sublingual route (SLIT) increases the threshold of reactivity to peanut, cow's milk, egg, wheat, and many other foods in the majority of the treated individuals. This desensitized state is contingent upon the continued ingestion of the maintenance doses of the food. Permanent oral tolerance is achievable in a smaller subset of the treated individuals. The optimal duration of therapy has not been firmly established but is likely dependent on the phenotype (severity and persistence). Efficacy of food-OIT is superior compared with SLIT, whereas the safety of OIT is less favorable. Standardization of treatment protocols, maintenance dosing, duration of therapy, target populations and harmonization of the outcomes are top priorities at this stage. OIT and SLIT represent two different routes of food allergen-specific immunotherapy. Although significant progress has been made in the last decade, both treatment modalities are still in the very early stages of development and further investigations are necessary to optimize the protocols and improve safety while maximizing efficacy.

Emerging Approaches to Food Desensitization in Children.

The purpose of this review is to highlight the recent advances in food desensitization in children with food allergy. Recent advancements in epicutaneous, sublingual, and oral immunotherapy for food allergy in the future may offer children with food allergy and their families a viable option to reduce risk or severity of anaphylaxis with phase III trials ongoing for two of these treatment modalities. Food allergy prevalence in children is estimated to be up to 8%. These children are at risk of significant allergic reactions and anaphylaxis. Food avoidance and use of antihistamines or epinephrine has been the standard of care for these patients. This approach also has a significant socioeconomic effects on patients and their families. Recent advancements in understanding food allergy have allowed for exploring new methods of treatment. There is an increasing interest in oral immunotherapy, epicutaneous immunotherapy, or sublingual immunotherapy for food allergy. There have been also innovative approaches to immunotherapy by modification of food allergens (to make them less allergenic while maintain their immunogenicity) or adding adjunctive treatments (probiotics, anti-IgE, etc.) to increase efficacy or safety.

Sublingual Immunotherapy in Children

Allergic rhinitis and food allergies are two of the most prevalent chronic medical diseases affecting children. Poorly controlled allergic rhinitis symptoms may impact quality of life and missed school days. Recent clinical trials have demonstrated that sublingual immunotherapy is effective in decreasing hypersensitivity to allergens such as dust mite, pollens, and cockroach. Research evaluating efficacy of sublingual immunotherapy for peanuts is promising; however, sublingual immunotherapy for food allergy should only be performed in a research setting until further evidence demonstrates consistent safety. Sublingual immunotherapy is an effective and safe alternative to more traditional subcutaneous immunotherapy, is well tolerated, and has good compliance among pediatric patients. The majority of adverse events with sublingual immunotherapy are reported as minor and have a lower systemic complication rate compared to subcutaneous immunotherapy, an important consideration among children.

Progress in sublingual immunotherapy for food allergy

The incidence of food allergy has increased in recent years.The current management of food allergy includes strict dietary avoidance and rapid medical treatment in case of accidental exposure.As a new immunotherapy method, sublingual immunotherapy has shown promising as alternative treatment for food allergy.This review discusses the clinical effectiveness and safety of sublingual immunotherapy for food allergy that are recently being investigated. Key words: Food allergy; Sublingual immunotherapy; Safety; Effectiveness

Immunotherapy for food allergies: a myth or a reality?

Food allergy is a worldwide issue, with an estimated prevalence of 2-10%. An effective treatment is not available for people affected and the only management is the avoidance of the allergen. Oral immunotherapy and sublingual immunotherapy have been tested by several authors, in particular for milk, egg and peanuts allergy, with significant results in term of desensitization induction. The achievement of tolerance is by the contrary doubtful, with different results obtained. In this review, we reviewed protocols of oral and sublingual immunotherapy for food allergy published in literature, mainly against milk, egg and peanut. At present, immunotherapy does not represent the gold standard in the treatment of food allergy, even if it can desensitize patients.

Use of Omp16 as a mucosal adjuvant in a sublingual immunotherapy for food allergy

Use of Omp16 as a mucosal adjuvant in a sublingual immunotherapy for food allergy

Oral and sublingual immunotherapy for food allergy

Oral and sublingual immunotherapy for food allergy

Oral and sublingual immunotherapy for food allergy: current progress and future directions

Oral and sublingual immunotherapy for food allergy: current progress and future directions

162 Establishing the Effectiveness, Cost-Effectiveness and Safety of Oral and Sublingual Immunotherapy for Food Allergy

BackgroundOral and sublingual immunotherapy to food allergens aim to enable the safe consumption of the foods containing these allergens.MethodsSystematic review of intervention studies, searching 11 international databases and contacting an international panel of experts. Studies were critically appraised using the Cochrane approach and meta-analysed.ResultsWe identified 721 potentially relevant papers, from which we selected 16 reports of 14 eligible trials (12 randomised controlled trials and 2 controlled clinical trials). Eleven of these trials evaluated oral immunotherapy and the remaining 3 investigated sublingual immunotherapy.Meta-analysis revealed that immunotherapy substantially reduced the average risk of persisting food allergy in patients (RR = 0.24; 95% CI, 0.11-0.50). Pooling of the safety data however revealed an increased average risk of systemic adverse reactions in those receiving immunotherapy (RR = 1.13; 95% CI, 1.00-1.27); the average risk of local (minor oropharyngeal/gastro-intestinal) adverse reactions was also increased in those receiving immunotherapy (RR = 1.16; 95% CI, 1.04, 1.30). Meta-analysis of immunological data demonstrated that allergen skin prick test wheal diameter significantly decreased in experimental groups compared to controls (mean difference –2.96 mm; 95% CI, –4.48, –1.45), whilst specific-IgG4 increased by an average of 19.9 μg/mL (95% CI, 17.1, 22.6); however there was no change in specific IgE: –5.2 kU/L (95% CI, –12.39, 1.99).ConclusionsOral/sublingual immunotherapy substantially reduces the risk of food allergy, this effect being mediated by immunological mechanisms. However, because of the stringent exclusion criteria used in many of the reviewed studies and the increased risk of systemic adverse events, immunotherapy cannot yet be recommended for routine clinical practice. Future research needs to focus on larger randomised controlled trials investigating long-term clinical tolerance induction, impact on quality of life and estimating the cost-effectiveness of treatment. Overall, this appears to be a promising line of potentially disease-modifying treatment for people with a range of IgE-mediated food allergies.

Specific Oral Tolerance Induction in Food Allergy in Children: Efficacy and Clinical Patterns of Reaction

Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K. Allergy. 2007;62(11):1261–1269 PURPOSE OF THE STUDY. To evaluate the efficacy of oral tolerance induction as a treatment for cow's milk and egg allergies. STUDY POPULATION. Forty-seven children aged 0.6 to 12.9 years with positive double-blind, placebo-controlled food challenges to milk or hen's egg were included in this German study. Children with severe eczema were excluded. METHODS. Subjects were randomly assigned to specific oral tolerance induction or continued avoidance. Treatment involved home escalation over at least 67 days from a dose of 1 drop of cow's milk to 250 mL or from 5 mg of lyophilized hen egg powder to 3500 mg. Subjects continued home dosing for a median of 21 months total, after which time they underwent a secondary period of avoidance for 2 months followed by a food challenge. RESULTS. At follow-up challenge, 9 (36%) of 25 children in the specific-oral-tolerance-induction group showed permanent tolerance, 3 (12%) of 25 were tolerant with regular intake, 4 (16%) of 25 were partial responders, and 9 (36%) of 25 did not complete the treatment because of adverse effects. In the control group, 7 (35%) of 20 children were tolerant at the study end. Allergen-specific IgE levels decreased in children who developed tolerance both in the control (P < .05) and treatment (P < .001) groups. CONCLUSIONS. Specific oral tolerance induction may be a valid treatment option for patients with persistent food allergy. However, only a minority of patients had evidence of persistent tolerance once treatment was stopped, with some unable to tolerate the therapy and others seeming to be only transiently desensitized. REVIEWER COMMENTS. Allergen-specific immunotherapy with injected extracts has proven too dangerous to be a viable treatment method for food allergy. Sublingual or oral immunotherapy, as described here, is a promising alternative to strict avoidance. Although one third of the patients in this study had to withdraw because of adverse effects, the remaining patients were able to incorporate the allergen into their diet at some level. This treatment modality is highly promising, but it is still experimental, carries the potential for significant risk, and requires close monitoring by experienced physicians. Several studies of oral and sublingual immunotherapy for food allergy are ongoing in the United States and Europe.

Specific immunotherapy for food allergy: basic principles and clinical aspects

Food allergy may be life threatening and its management continues to consist of avoiding relevant allergens and, in the case of accidental ingestion, initiation of appropriate emergency therapy. The aim of this article is to describe current treatment approaches and discuss attempts to use specific immunotherapy for food-allergy treatment. A recent study reports the use of sublingual immunotherapy for hazelnut food allergy in hazelnut-allergic patients. A significant increase in tolerance to hazelnuts after sublingual immunotherapy as assessed by double-blind, placebo-controlled food challenge, and good tolerance to this treatment, have been observed. The purpose of this review is to highlight the most promising novel approaches for treating food allergy beyond allergen avoidance. Some of these approaches alone, such as traditional Chinese herbal medicine, anti-immunoglobulin E therapy or sublingual immunotherapy for food allergy, or the combination of different approaches, would probably offer the best treatment option for food-allergic patients in the near future.