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Seminars in Immunopathology

, Volume 34, Issue 5, pp 689–702 | Cite as

Immunological mechanisms for desensitization and tolerance in food allergy

  • Rima Rachid
  • Dale T. Umetsu
Review

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.

Keywords

Food allergy Immunotherapy Desensitization Tolerance 

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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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Karp Laboratories, Division of Immunology and AllergyBoston Children’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

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