Clinical Reviews in Allergy & Immunology

, Volume 46, Issue 3, pp 250–257

Novel Approaches to Food Allergy

Article

Abstract

Food allergies have increased in recent decades. However, they cannot be effectively treated by the current management, which is limited to the identification and avoidance of foods that induce allergies and to the use of medicines for symptoms relief. To meet the medical need of prevention and cure of food allergies, several therapeutic strategies are under investigation. Some newly developed biologics such as anti-IgE antibody and anti-interleukin (IL)-5 antibody directed against significant molecules in the allergic process have shown their potential for the treatment of food allergies. Allergen-specific immunotherapy is the therapy that induces immune tolerance and may reduce the need for conventional medication, severity of allergic symptoms and eliminate hypersensitivity. In this article, clinical studies of immunotherapy via subcutaneous, oral, sublingual, and epicutaneous routes are extensively reviewed for their safety and effectiveness on various food allergies. In addition, to reduce the risk of anaphylaxis and increase toleragenic immunity, many studies are focusing on the modification of traditional allergens used for immunotherapy. Moreover, a Chinese herbal formulation with potential anti-allergic effects is being evaluated for its efficacy in patients with peanut allergy. Although more studies are needed, accumulated data of current studies represent compelling evidence of curative effects of some strategies and give a hope that food allergies are likely to be successfully treated in the future.

Keywords

Food allergy Biologics Immunotherapy Pharmaceuticals 

References

  1. 1.
    Sicherer SH (2011) Epidemiology of food allergy. J Allergy Clin Immunol 127:594–602PubMedCrossRefGoogle Scholar
  2. 2.
    Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA (2010) US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 125:1322–1326PubMedCrossRefGoogle Scholar
  3. 3.
    Sicherer SH, Sampson HA (2010) Food allergy. J Allergy Clin Immunol 125:S116–S125PubMedCrossRefGoogle Scholar
  4. 4.
    Wang J, Sampson HA (2011) Food allergy. J Clin Invest 121:827–835PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Nowak-Wegrzyn A, Sampson HA (2011) Future therapies for food allergies. J Allergy Clin Immunol 127:558–573PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Grimbaldeston MA, Metz M, Yu M, Tsai M, Galli SJ (2006) Effector and potential immunoregulatory roles of mast cells in IgE-associated acquired immune responses. Curr Opin Immunol 18:751–760PubMedCrossRefGoogle Scholar
  7. 7.
    Gupta R, Sheikh A, Strachan DP, Anderson HR (2007) Time trends in allergic disorders in the UK. Thorax 62:91–96PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Decker WW, Campbell RL, Manivannan V, Luke A, St Sauver JL et al (2008) The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol 122:1161–1165PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Scheinfeld N (2005) Omalizumab: a recombinant humanized monoclonal IgE-blocking antibody. Dermatol Online J 11:2PubMedGoogle Scholar
  10. 10.
    Leung DY, Sampson HA, Yunginger JW, Burks AW Jr, Schneider LC et al (2003) Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med 348:986–993PubMedCrossRefGoogle Scholar
  11. 11.
    Sampson HA, Leung DY, Burks AW, Lack G, Bahna SL et al (2011) A phase II, randomized, double-blind, parallel group, placebo-controlled oral food challenge trial of Xolair (omalizumab) in peanut allergy. J Allergy Clin Immunol 127:1309–1310PubMedCrossRefGoogle Scholar
  12. 12.
    Rafi A, Do LT, Katz R, Sheinkopf LE, Simons CW et al (2010) Effects of omalizumab in patients with food allergy. Allergy Asthma Proc 31:76–83PubMedCrossRefGoogle Scholar
  13. 13.
    Casale TB, Busse WW, Kline JN, Ballas ZK, Moss MH et al (2006) Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis. J Allergy Clin Immunol 117:134–140PubMedCrossRefGoogle Scholar
  14. 14.
    Kamin W, Kopp MV, Erdnuess F, Schauer U, Zielen S et al (2010) Safety of anti-IgE treatment with omalizumab in children with seasonal allergic rhinitis undergoing specific immunotherapy simultaneously. Pediatr Allergy Immunol 21:e160–e165PubMedCrossRefGoogle Scholar
  15. 15.
    Stone KD, Prussin C (2008) Immunomodulatory therapy of eosinophil-associated gastrointestinal diseases. Clin Exp Allergy 38:1858–1865PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Garrett JK, Jameson SC, Thomson B, Collins MH, Wagoner LE et al (2004) Anti-interleukin-5 (mepolizumab) therapy for hypereosinophilic syndromes. J Allergy Clin Immunol 113:115–119PubMedCrossRefGoogle Scholar
  17. 17.
    Straumann A, Conus S, Grzonka P, Kita H, Kephart G et al (2010) Anti-interleukin-5 antibody treatment (mepolizumab) in active eosinophilic oesophagitis: a randomised, placebo-controlled, double-blind trial. Gut 59:21–30PubMedCrossRefGoogle Scholar
  18. 18.
    Krishna MT, Huissoon AP (2011) Clinical immunology review series: an approach to desensitization. Clin Exp Immunol 163:131–146PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Frew AJ (2010) Allergen immunotherapy. J Allergy Clin Immunol 125:S306–S313PubMedCrossRefGoogle Scholar
  20. 20.
    Akdis CA, Akdis M (2011) Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol 127:18–27PubMedCrossRefGoogle Scholar
  21. 21.
    Oppenheimer JJ, Nelson HS, Bock SA, Christensen F, Leung DY (1992) Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol 90:256–262PubMedCrossRefGoogle Scholar
  22. 22.
    Nelson HS, Lahr J, Rule R, Bock A, Leung D (1997) Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol 99:744–751PubMedCrossRefGoogle Scholar
  23. 23.
    Katelaris CH (2010) Food allergy and oral allergy or pollen-food syndrome. Curr Opin Allergy Clin Immunol 10:246–251PubMedCrossRefGoogle Scholar
  24. 24.
    Asero R (1998) Effects of birch pollen-specific immunotherapy on apple allergy in birch pollen-hypersensitive patients. Clin Exp Allergy 28:1368–1373PubMedCrossRefGoogle Scholar
  25. 25.
    Bucher X, Pichler WJ, Dahinden CA, Helbling A (2004) Effect of tree pollen specific, subcutaneous immunotherapy on the oral allergy syndrome to apple and hazelnut. Allergy 59:1272–1276PubMedCrossRefGoogle Scholar
  26. 26.
    Kulis M, Vickery BP, Burks AW (2011) Pioneering immunotherapy for food allergy: clinical outcomes and modulation of the immune response. Immunol Res 49:216–226PubMedCrossRefGoogle Scholar
  27. 27.
    Beyer K, Wahn U (2008) Oral immunotherapy for food allergy in children. Curr Opin Allergy Clin Immunol 8:553–556PubMedCrossRefGoogle Scholar
  28. 28.
    Skripak JM, Nash SD, Rowley H, Brereton NH, Oh S et al (2008) A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow's milk allergy. J Allergy Clin Immunol 122:1154–1160PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Longo G, Barbi E, Berti I, Meneghetti R, Pittalis A (2008) Specific oral tolerance induction in children with very severe cow's milk-induced reactions. J Allergy Clin Immunol 121:343–347PubMedCrossRefGoogle Scholar
  30. 30.
    Pajno GB, Caminiti L, Ruggeri P, De Luca R, Vita D (2010) Oral immunotherapy for cow's milk allergy with a weekly up-dosing regimen: a randomized single-blind controlled study. Ann Allergy Asthma Immunol 105:376–381PubMedCrossRefGoogle Scholar
  31. 31.
    Buchanan AD, Green TD, Jones SM, Scurlock AM, Christie L (2007) Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol 119:199–205PubMedCrossRefGoogle Scholar
  32. 32.
    Vickery BP, Pons L, Kulis M, Steele P, Jones SM (2010) Individualized IgE-based dosing of egg oral immunotherapy and the development of tolerance. Ann Allergy Asthma Immunol 105:444–450PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Clark AT, Islam S, King Y, Deighton J, Anagnostou K (2009) Successful oral tolerance induction in severe peanut allergy. Allergy 64:1218–1220PubMedCrossRefGoogle Scholar
  34. 34.
    Jones SM, Pons L, Roberts JL, Scurlock AM, Perry TT et al (2009) Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol 124:292–300PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Varshney P, Jones SM, Scurlock AM, Perry TT, Kemper A et al (2011) A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol 127:654–660PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Lin SY, Leatherman B (2011) Sublingual immunotherapy. Otolaryngol Clin North Am 44:753–764PubMedCrossRefGoogle Scholar
  37. 37.
    Fernandez-Rivas M, Garrido Fernandez S, Nadal JA, Diaz de Durana MD, Garcia BE et al (2009) Randomized double-blind, placebo-controlled trial of sublingual immunotherapy with a Pru p 3 quantified peach extract. Allergy 64:876–883PubMedCrossRefGoogle Scholar
  38. 38.
    Enrique E, Pineda F, Malek T, Bartra J, Basagana M et al (2005) Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. J Allergy Clin Immunol 116:1073–1079PubMedCrossRefGoogle Scholar
  39. 39.
    Kim EH, Bird JA, Kulis M, Laubach S, Pons L et al (2011) Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol 127:640–646PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Kinaciyan T, Jahn-Schmid B, Radakovics A, Zwolfer B, Schreiber C et al (2007) Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1 homolog Mal d 1. J Allergy Clin Immunol 119:937–943PubMedCrossRefGoogle Scholar
  41. 41.
    Senti G, von Moos S, Kundig TM (2011) Epicutaneous allergen administration: is this the future of allergen-specific immunotherapy? Allergy 66:798–809PubMedCrossRefGoogle Scholar
  42. 42.
    Scurlock AM, Jones SM (2010) An update on immunotherapy for food allergy. Curr Opin Allergy Clin Immunol 10:587–593PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Dupont C, Kalach N, Soulaines P, Legoue-Morillon S, Piloquet H et al (2010) Cow's milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol 125:1165–1167PubMedCrossRefGoogle Scholar
  44. 44.
    Ferreira F, Briza P, Infuhr D, Schmidt G, Wallner M et al (2006) Modified recombinant allergens for safer immunotherapy. Inflamm Allergy Drug Targets 5:5–14PubMedCrossRefGoogle Scholar
  45. 45.
    Nowak-Wegrzyn A, Bloom KA, Sicherer SH, Shreffler WG, Noone S et al (2008) Tolerance to extensively heated milk in children with cow's milk allergy. J Allergy Clin Immunol 122:342–347PubMedCrossRefGoogle Scholar
  46. 46.
    Lemon-Mule H, Sampson HA, Sicherer SH, Shreffler WG, Noone S et al (2008) Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol 122:977–983PubMedCrossRefGoogle Scholar
  47. 47.
    Kim JS, Nowak-Wegrzyn A, Sicherer SH, Noone S, Moshier EL et al (2011) Dietary baked milk accelerates the resolution of cow's milk allergy in children. J Allergy Clin Immunol 128:125–131PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Tanabe S (2007) Epitope peptides and immunotherapy. Curr Protein Pept Sci 8:109–118PubMedCrossRefGoogle Scholar
  49. 49.
    Chuang YH, Yang YH, Wu SJ, Chiang BL (2009) Gene therapy for allergic diseases. Curr Gene Ther 9:185–191PubMedCrossRefGoogle Scholar
  50. 50.
    Chua KY, Huangfu T, Liew LN (2006) DNA vaccines and allergic diseases. Clin Exp Pharmacol Physiol 33:546–550PubMedCrossRefGoogle Scholar
  51. 51.
    Li XM, Srivastava K, Grishin A, Huang CK, Schofield B et al (2003) Persistent protective effect of heat-killed Escherichia coli producing "engineered," recombinant peanut proteins in a murine model of peanut allergy. J Allergy Clin Immunol 112:159–167PubMedCrossRefGoogle Scholar
  52. 52.
    DeLong JH, Simpson KH, Wambre E, James EA, Robinson D et al (2011) Ara h 1-reactive T cells in individuals with peanut allergy. J Allergy Clin Immunol 127:1211–1218PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Li X, Huang CK, Schofield BH, Burks AW, Bannon GA et al (1999) Strain-dependent induction of allergic sensitization caused by peanut allergen DNA immunization in mice. J Immunol 162:3045–3052PubMedGoogle Scholar
  54. 54.
    Li XM, Zhang TF, Huang CK, Srivastava K, Teper AA et al (2001) Food Allergy Herbal Formula-1 (FAHF-1) blocks peanut-induced anaphylaxis in a murine model. J Allergy Clin Immunol 108:639–646PubMedCrossRefGoogle Scholar
  55. 55.
    Srivastava KD, Kattan JD, Zou ZM, Li JH, Zhang L et al (2005) The Chinese herbal medicine formula FAHF-2 completely blocks anaphylactic reactions in a murine model of peanut allergy. J Allergy Clin Immunol 115:171–178PubMedCrossRefGoogle Scholar
  56. 56.
    Wang J, Patil SP, Yang N, Ko J, Lee J et al (2010) Safety, tolerability, and immunologic effects of a food allergy herbal formula in food allergic individuals: a randomized, double-blinded, placebo-controlled, dose escalation, phase 1 study. Ann Allergy Asthma Immunol 105:75–84PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Pediatrics, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  2. 2.Department of Medical Research, National Taiwan University Hospital, Graduate Institute of Clinical Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan

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