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Immunological mechanisms for desensitization and tolerance in food allergy

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Abstract

Food allergy is a major public health concern in westernized countries, estimated to affect 5 % of children and 3–4 % of adults. Allergen-specific immunotherapy for food allergy is currently being actively evaluated, but is still experimental. The optimal protocol, in terms of the route of administration of the food, target maintenance dose, and duration of maintenance therapy, and the optimal patient for these procedures are still being worked out. The mechanisms underlying successful food desensitization are also unclear, in part, because there is no standard immunotherapy protocol. The mechanisms involved, however, may include mast cell and basophil suppression, development of food-specific IgG4 antibodies, reduction in the food-specific IgE/IgG4 ratio, up-regulation and expansion of natural or inducible regulatory T cells, a skewing from a Th2 to a Th1 profile, and the development of anergy and/or deletion in antigen-specific cells. Additional studies are required to elucidate and understand these mechanisms by which desensitization and tolerance are achieved, which may reveal valuable biomarkers for evaluating and following food allergic patients on immunotherapy.

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Abbreviations

DBPCFC:

Double-blind placebo-controlled food challenge

iTRegs :

Inducible regulatory T cells

IT:

Immunotherapy

mAb:

Monoclonal antibody

nTRegs :

Natural regulatory T cells

OFC:

Oral food challenge

OIT:

Oral immunotherapy

SIgA:

Secretory IgA

SLIT:

Sublingual immunotherapy

SPT:

Skin prick test

Syk:

Spleen tyrosine kinase

TRegs :

Regulatory T cells

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Authors and Affiliations

  1. Karp Laboratories, Division of Immunology and Allergy, Boston Children’s Hospital, Rm 10127, One Blackfan Circle, Boston, MA, 02115, USA

    Rima Rachid & Dale T. Umetsu

  2. Harvard Medical School, Boston, MA, USA

    Rima Rachid & Dale T. Umetsu

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  1. Rima Rachid
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  2. Dale T. Umetsu
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Correspondence to Dale T. Umetsu.

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This article is published as part of the Special Issue on Food Allergy [34:6].

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Rachid, R., Umetsu, D.T. Immunological mechanisms for desensitization and tolerance in food allergy. Semin Immunopathol 34, 689–702 (2012). https://doi.org/10.1007/s00281-012-0333-9

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