Skip to main content

Oral immunotherapy for food allergy

Current Allergy and Asthma Reports volume 9, pages 43–49 (2009)Cite this article

Abstract

Current management of food allergy involves strict avoidance, education on recognizing and managing allergic reactions, and carrying an adrenaline autoinjector. This approach is burdensome and associated with reduced quality of life. Patients with food allergy would benefit greatly from a treatment that could achieve desensitization or long-term tolerance. Recent studies have shown that oral immunotherapy (OIT) can induce desensitization and modulate allergen-specific immune responses; however, it remains uncertain whether OIT can induce long-term tolerance. Nevertheless, successful desensitization provides a major advance in management by reducing the risk of reaction to low amounts of allergen. Allergic reactions during OIT are common, although severe reactions are less common. Therefore, OIT should be performed in specialist centers under close medical supervision and would ideally be conducted as part of ongoing research studies. OIT holds promise as a novel approach to managing food allergy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. Gupta R, Sheikh A, Strachan DP, et al.: Time trends in allergic disorders in the UK. Thorax 2007, 62:91–96.

    PubMed  Article  CAS  Google Scholar 

  2. Robertson CF, Roberts MF, Kappers JH: Asthma prevalence in Melbourne schoolchildren: have we reached the peak? Med J Aust 2004, 180:273–276.

    PubMed  Google Scholar 

  3. Poulos LM, Waters AM, Correll PK, et al.: Trends in hospitalizations for anaphylaxis, angioedema, and urticaria in Australia, 1993–1994 to 2004–2005. J Allergy Clin Immunol 2007, 120:878–884.

    PubMed  Article  Google Scholar 

  4. Grundy J, Matthews S, Bateman B, et al.: Rising prevalence of allergy to peanut in children: data from 2 sequential cohorts. J Allergy Clin Immunol 2002, 110:784–789.

    PubMed  Article  Google Scholar 

  5. Sicherer SH, Muñoz-Furlong A, Sampson HA: Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003, 112:1203–1207.

    PubMed  Article  Google Scholar 

  6. Sicherer SH, Sampson HA: 9. Food allergy. J Allergy Clin Immunol 2006, 117(2 Suppl Mini-Primer):S470–S475.

    PubMed  Article  CAS  Google Scholar 

  7. Venter C, Pereira B, Voigt K, et al.: Prevalence and cumulative incidence of food hypersensitivity in the first 3 years of life. Allergy 2008, 63:354–359.

    PubMed  Article  CAS  Google Scholar 

  8. Hourihane JO, Aiken R, Briggs R, et al.: The impact of government advice to pregnant mothers regarding peanut avoidance on the prevalence of peanut allergy in United Kingdom children at school entry. J Allergy Clin Immunol 2007, 119:1197–1202.

    PubMed  Article  Google Scholar 

  9. Kemp SF, Lockey RF, Wolf BL, et al.: Anaphylaxis. A review of 266 cases. Arch Intern Med 1995, 155:1749–1754.

    PubMed  Article  CAS  Google Scholar 

  10. Pumphrey RS, Gowland MH: Further fatal allergic reactions to food in the United Kingdom, 1999–2006. J Allergy Clin Immunol 2007, 119:1018–1019.

    PubMed  Article  Google Scholar 

  11. Hourihane JO, Roberts SA, Warner JO: Resolution of peanut allergy: case-control study. BMJ 1998, 316:1271–1275.

    PubMed  CAS  Google Scholar 

  12. Skolnick HS, Conover-Walker MK, Koerner CB, et al.: The natural history of peanut allergy. J Allergy Clin Immunol 2001, 107:367–374.

    PubMed  Article  CAS  Google Scholar 

  13. Bock SA, Atkins FM: The natural history of peanut allergy. J Allergy Clin Immunol 1989, 83:900–904.

    PubMed  Article  CAS  Google Scholar 

  14. de Silva IL, Mehr SS, Tey D, et al.: Paediatric anaphylaxis: a 5 year retrospective review. Allergy 2008, 63:1071–1076.

    PubMed  Article  Google Scholar 

  15. Sicherer SH, Burks AW, Sampson HA: Clinical features of acute allergic reactions to peanut and tree nuts in children. Pediatrics 1998, 102:e6.

    PubMed  Article  CAS  Google Scholar 

  16. Vander Leek TK, Liu AH, Stefanski K, et al.: The natural history of peanut allergy in young children and its association with serum peanut-specific IgE. J Pediatr 2000, 137:749–755.

    Article  Google Scholar 

  17. Bock SA, Muñoz-Furlong A, Sampson HA: Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol 2007, 119:1016–1018.

    PubMed  Article  Google Scholar 

  18. Tang ML-K, Liew WK: Prevention and treatment of anaphylaxis. Paediatrics Child Health 2008, 18:309–316.

    Article  Google Scholar 

  19. Primeau MN, Kagan R, Joseph L, et al.: The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut-allergic children. Clin Exp Allergy 2000, 30:1135–1143.

    PubMed  Article  CAS  Google Scholar 

  20. Mehr S, Robinson M, Tang M: Doctor—how do I use my EpiPen? Pediatr Allergy Immunol 2006, 18:448–452.

    Article  Google Scholar 

  21. Sicherer SH, Forman JA, Noone SA: Use assessment of self-administered epinephrine among food-allergic children and pediatricians. Pediatrics 2000, 105:359–362.

    PubMed  Article  CAS  Google Scholar 

  22. Simons ECW, Muñoz-Furlong A, Furlong TJ, et al.: Management of food-induced anaphylaxis by caregivers and medical professionals: a survey. J Allergy Clin Immunol 2006, 117(Suppl 1):S134–S135.

    Article  Google Scholar 

  23. Burks AW, Laubach S, Jones SM: Oral tolerance, food allergy, and immunotherapy: implications for future treatment. J Allergy Clin Immunol 2008, 121:1344–1350.

    PubMed  Article  CAS  Google Scholar 

  24. Strobel S, Mowat AM: Oral tolerance and allergic responses to food proteins. Curr Opin Allergy Clin Immunol 2006, 6:207–213.

    PubMed  CAS  Article  Google Scholar 

  25. Chen Y, Kuchroo VK, Inobe J, et al.: Regulatory T cell clones induced by oral tolerance: suppression of autoimmune encephalomyelitis. Science 1994, 265:1237–1240.

    PubMed  Article  CAS  Google Scholar 

  26. Groux H, O’Garra A, Bigler M, et al.: A CD4+ T-cell subset inhibits antigen-specific T-cell responses and prevents colitis. Nature 1997, 389:737–742.

    PubMed  Article  CAS  Google Scholar 

  27. Chung Y, Lee SH, Kim DH, et al.: Complementary role of CD4+CD25+ regulatory T cells and TGF-beta in oral tolerance. J Leukoc Biol 2005, 77:906–913.

    PubMed  Article  CAS  Google Scholar 

  28. Frossard CP, Hauser C, Eigenmann PA: Antigen-specific secretory IgA antibodies in the gut are decreased in a mouse model of food allergy. J Allergy Clin Immunol 2004, 114:377–382.

    PubMed  Article  CAS  Google Scholar 

  29. Perez-Machado MA, Ashwood P, Thomson MA, et al.: Reduced transforming growth factor-beta1-producing T cells in the duodenal mucosa of children with food allergy. Eur J Immunol 2003, 33:2307–2315.

    PubMed  Article  CAS  Google Scholar 

  30. Beyer K, Castro R, Birnbaum A, et al.: Human milk-specific mucosal lymphocytes of the gastrointestinal tract display a Th2 cytokine profile. J Allergy Clin Immunol 2002, 109:707–713.

    PubMed  Article  CAS  Google Scholar 

  31. Chung HL, Hwang JB, Park JJ, et al.: Expression of transforming growth factor beta1, transforming growth factor type I and II receptors, and TNF-alpha in the mucosa of the small intestine in infants with food protein-induced enterocolitis syndrome. J Allergy Clin Immunol 2002, 109:150–154.

    PubMed  Article  CAS  Google Scholar 

  32. Karlsson MR, Rugtveit J, Brandtzaeg P: Allergen-responsive CD4+CD25+ regulatory T cells in children who have outgrown cow’s milk allergy. J Exp Med 2004, 199:1679–1688.

    PubMed  Article  CAS  Google Scholar 

  33. Turcanu V, Maleki SJ, Lack G: Characterization of lymphocyte responses to peanuts in normal children, peanut-allergic children, and allergic children who acquired tolerance to peanuts. J Clin Invest 2003, 111:1065–1072.

    PubMed  CAS  Google Scholar 

  34. Norman PS: Immunotherapy: 1999–2004. J Allergy Clin Immunol 2004, 113:1013–1023; quiz 1024.

    PubMed  Article  CAS  Google Scholar 

  35. Schmidt-Weber CB, Blaser K: Immunological mechanisms in specific immunotherapy. Springer Semin Immunopathol 2004, 25:377–390.

    PubMed  Article  Google Scholar 

  36. Nelson HS, Lahr J, Rule R, et al.: Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol 1997, 99:744–751.

    PubMed  Article  CAS  Google Scholar 

  37. Bauer A, Ekanayake Mudiyanselage S, Wigger-Alberti W, Elsner P: Oral rush desensitization to milk. Allergy 1999, 54:894–895.

    PubMed  Article  CAS  Google Scholar 

  38. Nucera E, Schiavino D, D’Ambrosio C, et al.: Immunological aspects of oral desensitization in food allergy. Dig Dis Sci 2000, 45:637–641.

    PubMed  Article  CAS  Google Scholar 

  39. Alonso R, Zapatero L, Fuentes V, et al.: Specific oral tolerance induction in 39 children with IgE mediated persistent cow’s milk allergy. J Allergy Clin Immunol 2008, 121(Suppl 1):S246.

    Article  Google Scholar 

  40. Patriarca G, Nucera E, Roncallo C, et al.: Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther 2003, 17:459–465.

    PubMed  Article  CAS  Google Scholar 

  41. Meglio P, Bartone E, Plantamura M, et al.: A protocol for oral desensitization in children with IgE-mediated cow’s milk allergy. Allergy 2004, 59:980–987.

    PubMed  Article  CAS  Google Scholar 

  42. Nash SD, Steele PH, Kamilaris JS, et al.: Oral peanut immunotherapy for children with peanut allergy. J Allergy Clin Immunol 2008, 121(Suppl 1):S136.

    Article  Google Scholar 

  43. Rolinck-Werninghaus C, Staden U, Mehl A, et al.: Specific oral tolerance induction with food in children: transient or persistent effect on food allergy? Allergy 2005, 60:1320–1322.

    PubMed  Article  CAS  Google Scholar 

  44. Buchanan AD, Green TD, Jones SM, et al.: Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol 2007, 119:199–205.

    PubMed  Article  CAS  Google Scholar 

  45. Staden U, Rolinck-Werninghaus C, Brewe F, et al.: Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy 2007, 62:1261–1269.

    PubMed  Article  CAS  Google Scholar 

  46. Longo G, Barbi E, Berti I, et al.: Specific oral tolerance induction in children with very severe cow’s milk-induced reactions. J Allergy Clin Immunol 2008, 121:343–347.

    PubMed  Article  CAS  Google Scholar 

  47. Blumchen K, Staden U, Ulbricht H, et al.: Rush specific oral tolerance induction in peanut allergic patients with high risk of anaphylactic reactions. J Allergy Clin Immunol 2008, 121(Suppl 1):S136.

    Article  Google Scholar 

  48. Nowak-Wegrzyn A, Bloom KA, Sicherer SH, et al.: Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol 2008, 122:342–347.

    PubMed  Article  Google Scholar 

  49. Enrique E, Pineda F, Malek T, et al.: Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. J Allergy Clin Immunol 2005, 116:1073–1079.

    PubMed  Article  CAS  Google Scholar 

  50. Kerzl R, Simonowa A, Ring J, et al.: Life-threatening anaphylaxis to kiwi fruit: protective sublingual allergen immunotherapy effect persists even after discontinuation. J Allergy Clin Immunol 2007, 119:507–508.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Allergy and Immunology, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052, Melbourne, Australia

    Mimi L. K. Tang

Authors
  1. Mimi L. K. Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mimi L. K. Tang.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tang, M.L.K. Oral immunotherapy for food allergy. Curr Allergy Asthma Rep 9, 43–49 (2009). https://doi.org/10.1007/s11882-009-0007-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-009-0007-4

Keywords

  • Food Allergy
  • Allergy Clin Immunol
  • Oral Tolerance
  • Peanut Allergy
  • Oral Immunotherapy