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Update on oral and epicutaneous immunotherapy for children with food allergy

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Abstract

Purpose

Several oral immunotherapies (OITs) are used to treat food allergies. Recently, several protocols have been implemented to ensure the safety of OITs with a growing trend towards implementing them in a larger patient population. Additionally, reports on follow-up immunotherapy using the transdermal route have been reported. In this review, we summarize the evidence on current immunotherapies for food allergy.

Methods

We selected and reviewed studies on OIT and epicutaneous immunotherapy (EPIT) that showed evidence of clinical efficacy and safety in patients with an immediate type of food allergy.

Results

Continuation of low-dose OIT is considered relatively safe in patients with severe food allergies with a gradual increase in the daily dose of the immunotherapeutic agents. OIT products could be introduced through desensitization protocols to prevent serious adverse reactions; however, appropriate methods should be used to continue their use. Combining omalizumab, antihistamines, or probiotics with OITs improves the safety. Compared to OIT, EPIT is generally safer but has a lower efficacy. Furthermore, OIT is effective in some young patients. However, the selection of participants in such cases is critical from a safety perspective. Long-term OIT at relatively high target doses is associated with serious safety concerns.

Conclusion

The implementation of recent treatment protocols has significantly improved the safety of OIT. Therefore, its continuation using safety protocols can be considered in the selection of the optimal OIT for individual patients, as provision of safe and effective treatment is crucial for the success of OIT.

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Abbreviations

AIT:

Allergen immunotherapy

AMED:

Agency for Medical Research and Development

CI:

Confidence interval

DBPCFC:

Double-blind, placebo-controlled food challenge

EPIT:

Epicutaneous immunotherapy

IgE:

Immunoglobulin E

IRR:

Incidence rate ratio

OFC:

Oral food challenge

OIT:

Oral immunotherapy

OR:

Odds ratio

PPOIT:

RCT of peanut OIT combined with probiotics

RCT:

Randomized clinical trial

SU:

Sustained unresponsiveness

VP:

Viaskin peanut

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Acknowledgements

We thank the medical staff and patients at the Sagamihara National Hospital Organization, Sagamihara National Hospital, Japan.

Funding

This work was funded by the Practical Research Project for Allergic Disease and Immunology of the Japan Agency for Medical Research and Development (AMED, 17ek0410019h0003).

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Authors and Affiliations

  1. Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan

    Yoko Miura MD & Noriyuki Yanagida MD

  2. Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Yoko Miura MD

  3. Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Minami-ku, Sagamihara, Kanagawa, Japan, 18-1, Sakuradai, 252-0392

    Sakura Sato MD, Noriyuki Yanagida MD & Motohiro Ebisawa MD, PhD

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  1. Yoko Miura MD
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  4. Motohiro Ebisawa MD, PhD
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Contributions

Dr. Miura contributed to this paper, and Dr. Yanagida and Dr. Sato performed data collection and article presentation, and Dr. Ebisawa supervised the research.

Corresponding author

Correspondence to Motohiro Ebisawa MD, PhD.

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Conflict of interest

M. Ebisawa received fees from DBV Technologies and Mylan to deliver lectures. Sakura Sato received fees from Mylan to deliver lectures. Y. Miura, S. Sato and N. Yanagida declare that they have no competing interests.

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Miura, Y., Sato, S., Yanagida, N. et al. Update on oral and epicutaneous immunotherapy for children with food allergy. Allergo J Int 32, 269–279 (2023). https://doi.org/10.1007/s40629-023-00256-7

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