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Emerging Approaches to Food Desensitization in Children

  • Pediatric Allergy and Immunology (W Dolen, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to highlight the recent advances in food desensitization in children with food allergy.

Recent Findings

Recent advancements in epicutaneous, sublingual, and oral immunotherapy for food allergy in the future may offer children with food allergy and their families a viable option to reduce risk or severity of anaphylaxis with phase III trials ongoing for two of these treatment modalities.

Summary

Food allergy prevalence in children is estimated to be up to 8%. These children are at risk of significant allergic reactions and anaphylaxis. Food avoidance and use of antihistamines or epinephrine has been the standard of care for these patients. This approach also has a significant socioeconomic effects on patients and their families. Recent advancements in understanding food allergy have allowed for exploring new methods of treatment. There is an increasing interest in oral immunotherapy, epicutaneous immunotherapy, or sublingual immunotherapy for food allergy. There have been also innovative approaches to immunotherapy by modification of food allergens (to make them less allergenic while maintain their immunogenicity) or adding adjunctive treatments (probiotics, anti-IgE, etc.) to increase efficacy or safety.

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References

Papers of particular interest, published recently, have been highlighted as: •Of Importance

  1. The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States. PEDIATRICS. 2011;128(1): peds.2011-0204d-peds.2011-0204d.

  2. Liu A, Jaramillo R, Sicherer S, Wood R, Bock S, Burks A, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126(4):798–806. e14

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kattan J. The prevalence and natural history of food allergy. Current Allergy and Asthma Reports. 2016;16(7):47.

    Article  PubMed  Google Scholar 

  4. • Yee CRachid R. The heterogeneity of oral immunotherapy clinical trials: implications and future directions. Current Allergy and Asthma Reports. 2016;16:25. The article is an excellent review of oral immunotherapy clinical trials in food allergy. There is an emphasis on the heterogeneity of these trials and what conclusions can be made based on them.

    Article  Google Scholar 

  5. Arasi S, Otani I, Klingbeil E, Bégin P, Kearney C, Dominguez T, et al. Two year effects of food allergen immunotherapy on quality of life in caregivers of children with food allergies. Allergy, Asthma Clin Immunol. 2014;10:57.

    Article  Google Scholar 

  6. Pajno G, Caminiti L, Salzano G, Crisafulli G, Aversa T, Messina M, et al. Comparison between two maintenance feeding regimens after successful cow's milk oral desensitization. Pediatr Allergy Immunol. 2013;24:376–81.

    Article  PubMed  Google Scholar 

  7. Jones S, Burks A, Keet C, Vickery B, Scurlock A, Wood R, et al. Long-term treatment with egg oral immunotherapy enhances sustained unresponsiveness that persists after cessation of therapy. J Allergy Clin Immunol. 2016;137:1117–27. e10

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Paassilta M, Salmivesi S, Mäki T, Helminen M, Korppi M. Children who were treated with oral immunotherapy for cows’ milk allergy showed long-term desensitisation seven years later. Acta Paediatr. 2015;105:215–9.

    Article  PubMed  Google Scholar 

  9. [Internet]. 2017 [cited 21 February 2017]. Available from: http://www.aimmune.com/wp-content/uploads/2015/05/EAACI-ARC-presentation-6-7-15.pdf

  10. Rodríguez del Río P, Díaz-Perales A, Sanchez-García S, Escudero C, Patricia do Santos, Catarino M et al. Oral immunotherapy in children with IgE-mediated wheat allergy: outcome and molecular changes. J Investig Allergol Clin Immunol. [Internet]. 2014 [cited 21 February 2017];. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25219106

  11. Jones S, Fleischer D, Sicherer S, Wood R, Lindblad R, Stablein D, et al. Egg oral immunotherapy (OIT) induces clinical desensitization in a double-blind, placebo-controlled (DBPC) trial in egg allergic children from the consortium of food allergy research (CoFAR). J Allergy Clin Immunol. 2010;125:AB357.

    Google Scholar 

  12. Bégin P, Winterroth L, Dominguez T, Wilson S, Bacal L, Mehrotra A, et al. Safety and feasibility of oral immunotherapy to multiple allergens for food allergy. Allergy, Asthma Clin Immunol. 2014;10:1.

    Article  Google Scholar 

  13. Nadeau K, Schneider L, Hoyte L, Borras I, Umetsu D. Rapid oral desensitization in combination with omalizumab therapy in patients with cow’s milk allergy. J Allergy Clin Immunol. 2011;127:1622–4.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Henson M, Edie A, Steele P, Kamilaris J, Kulis M, Thyagarajan A, et al. Peanut oral immunotherapy and omalizumab treatment for peanut allergy. J Allergy Clin Immunol. 2012;129:AB28.

    Article  Google Scholar 

  15. Bégin P, Dominguez T, Wilson S, Bacal L, Mehrotra A, Kausch B, et al. Phase 1 results of safety and tolerability in a rush oral immunotherapy protocol to multiple foods using omalizumab. Allergy, Asthma Clin Immunol. 2014;10:7.

    Article  Google Scholar 

  16. Schneider L, Rachid R, LeBovidge J, Blood E, Mittal M, Umetsu D. A pilot study of omalizumab to facilitate rapid oral desensitization in high-risk peanut-allergic patients. J Allergy Clin Immunol. 2013;132:1368–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. • Wood R, Kim J, Lindblad R, Nadeau K, Henning A, Dawson P, et al. A randomized, double-blind, placebo-controlled study of omalizumab combined with oral immunotherapy for the treatment of cow's milk allergy. J Allergy Clin Immunol. 2016;137:1103–10. e11. First randomized double blind placebo-controlled trial assessing role of omalizumab combined with immunotherapy.

    Article  CAS  PubMed  Google Scholar 

  18. • Tang M, Ponsonby A, Orsini F, Tey D, Robinson M, Su E, et al. Administration of a probiotic with peanut oral immunotherapy: a randomized trial. J Allergy Clin Immunol. 2015;135:737–44. e8.First randomized trial assessing role of probiotics administration combind with peanut OIT. However, there was no OIT only group.

    Article  CAS  PubMed  Google Scholar 

  19. Srivastava K, Li XM, Bannon GA, et al. Investigation of the use of ISS-linked Ara h2 for the treatment of peanut-induced allergy. J Allergy Clin Immunolo. 2011;107:S233. (Abstract)

    Google Scholar 

  20. Takahashi M, Taniuchi S, Soejima K, Sudo K, Hatano Y, Kaneko K. New efficacy of LTRAs (montelukast sodium): it possibly prevents food-induced abdominal symptoms during oral immunotherapy. Allergy, Asthma Clin Immunol. 2014;10:3.

    Article  Google Scholar 

  21. Burks A, Wood R, Jones S, Sicherer S, Fleischer D, Scurlock A, et al. Sublingual immunotherapy for peanut allergy: long-term follow-up of a randomized multicenter trial. J Allergy Clin Immunol. 2015;135:1240–8. e3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Fernández-Rivas M, Garrido Fernández S, Nadal J, Alonso Díaz de Durana M, García B, González-Mancebo E, et al. Randomized double-blind, placebo-controlled trial of sublingual immunotherapy with a Pru p 3 quantified peach extract. Allergy. 2009;64:876–83.

    Article  PubMed  Google Scholar 

  23. Chin S, Vickery B, Kulis M, Kim E, Varshney P, Steele P, et al. Sublingual versus oral immunotherapy for peanut-allergic children: a retrospective comparison. J Allergy Clin Immunol. 2013;132:476–8. e2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Narisety S, Frischmeyer-Guerrerio P, Keet C, Gorelik M, Schroeder J, Hamilton R, et al. A randomized, double-blind, placebo-controlled pilot study of sublingual versus oral immunotherapy for the treatment of peanut allergy. J Allergy Clin Immunol. 2015;135:1275–82. e6

    Article  CAS  PubMed  Google Scholar 

  25. Keet C, Frischmeyer-Guerrerio P, Thyagarajan A, Schroeder J, Hamilton R, Boden S, et al. The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol. 2012;129:448–55. e5

    Article  CAS  PubMed  Google Scholar 

  26. Dupont C, Kalach N, Soulaines P, Legoué-Morillon S, Piloquet H, Benhamou P. Cow's milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol. 2010;125:1165–7.

    Article  CAS  PubMed  Google Scholar 

  27. Sampson H, Agbotounou W, Thébault C, Charles R, Martin L, Yang W, et al. Epicutaneous immunotherapy (EPIT) is effective and safe to treat peanut allergy: a multi-National Double-Blind Placebo-Controlled Randomized Phase IIb trial. J Allergy Clin Immunol. 2015;135:AB390.

    Article  Google Scholar 

  28. Jones S, Agbotounou W, Fleischer D, Burks A, Pesek R, Harris M, et al. Safety of epicutaneous immunotherapy for the treatment of peanut allergy: a phase 1 study using the Viaskin patch. J Allergy Clin Immunol. 2016;137:1258–61. e10

    Article  PubMed  Google Scholar 

  29. Oppenheimer J, Nelson H, Bock S, Christensen F, Leung D. Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol. 1992;90:256–62.

    Article  CAS  PubMed  Google Scholar 

  30. Nelson H, Lahr J, Rule R, Bock A, Leung D. Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract1. J Allergy Clin Immunol. 1997;99:744–51.

    Article  CAS  PubMed  Google Scholar 

  31. Zuidmeer-Jongejan L, Huber H, Swoboda I, Rigby N, Versteeg S, Jensen B, et al. Development of a hypoallergenic recombinant parvalbumin for first-in-man subcutaneous immunotherapy of fish allergy. Int Arch Allergy Immunol. 2015;166:41–51.

    Article  CAS  PubMed  Google Scholar 

  32. Rupa PMine Y. Oral immunotherapy with immunodominant T-cell epitope peptides alleviates allergic reactions in a Balb/c mouse model of egg allergy. Allergy. 2011;67:74–82.

    Article  Google Scholar 

  33. Wood R, Sicherer S, Burks A, Grishin A, Henning A, Lindblad R, et al. A phase 1 study of heat/phenol-killed, E. coli -encapsulated, recombinant modified peanut proteins Ara h 1, Ara h 2, and Ara h 3 (EMP-123) for the treatment of peanut allergy. Allergy. 2013;68:803–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Ibanez M, Escudero C, Sánchez-García S, Rodríguez del Río P. Comprehensive review of current knowledge on egg oral immunotherapy. J Investig Allergol Clin Immunol. 2017;25(5):316–28. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26727760

    Google Scholar 

  35. Meglio P, Giampietro P, Carello R, Gabriele I, Avitabile S, Galli E. Oral food desensitization in children with IgE-mediated hen’s egg allergy: a new protocol with raw hen’s egg. Pediatr Allergy Immunol. 2012;24:75–83.

    Article  PubMed  Google Scholar 

  36. Leung D, Sampson H, Yunginger J, Burks W, Schneider L, Shanahan W. Effect of anti-IgE therapy (TNX-901) in patients with severe peanut allergy. J Allergy Clin Immunol. 2003;111:S274.

    Article  Google Scholar 

  37. Sampson H, Leung D, Burks A, Lack G, Bahna S, Jones S, et al. A phase II, randomized, double-blind, parallel-group, placebo-controlled oral food challenge trial of Xolair (omalizumab) in peanut allergy. J Allergy Clin Immunol. 2011;127:1309–10. e1

    Article  CAS  PubMed  Google Scholar 

  38. Wang J, Jones S, Pongracic J, Song Y, Yang N, Sicherer S, et al. Safety, clinical, and immunologic efficacy of a Chinese herbal medicine (food allergy herbal formula-2) for food allergy. J Allergy Clin Immunol. 2015;136:962–70. e1

    Article  PubMed  PubMed Central  Google Scholar 

  39. Goldberg M, Nachshon L, Appel M, Elizur A, Levy M, Eisenberg E, et al. Efficacy of baked milk oral immunotherapy in baked milk–reactive allergic patients. J Allergy Clin Immunol. 2015;136:1601–6.

    Article  CAS  PubMed  Google Scholar 

  40. Yeung J, Kloda L, McDevitt J, Ben-Shoshan M, Alizadehfar R. Oral immunotherapy for milk allergy: a systematic review. Allergy, Asthma Clin Immunol. 2012;8:A14.

    Article  Google Scholar 

  41. Levy M, Elizur A, Goldberg M, Nachshon L, Katz Y. Clinical predictors for favorable outcomes in an oral immunotherapy program for IgE-mediated cow's milk allergy. Annals of Allergy, Asthma & Immunology. 2014;112:58–63. e1

    Article  CAS  Google Scholar 

  42. Vazquez-Ortiz M, Alvaro M, Piquer M, Dominguez O, Machinena A, Martín-Mateos M, et al. Baseline specific IgE levels are useful to predict safety of oral immunotherapy in egg-allergic children. Clinical & Experimental Allergy. 2013;44:130–41.

    Article  Google Scholar 

  43. García-Ara C, Pedrosa M, Belver M, Martín-Muñoz M, Quirce S, Boyano-Martínez T. Efficacy and safety of oral desensitization in children with cow's milk allergy according to their serum specific IgE level. Annals of Allergy, Asthma & Immunology. 2013;110:290–29.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, 27517, USA

    Ahmad Hamad

  2. Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, USA

    Wesley A. Burks

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  1. Ahmad Hamad
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Corresponding author

Correspondence to Ahmad Hamad.

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Conflict of Interest

Dr. Burks reports grants from Food Allergy & Anaphylaxis Network, grants from National Institutes of Health, grants from Wallace Research Foundation, during the conduct of the study. Dr. Hamad declares no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Grants from National Institutes of Health, grants from Wallace Research Foundation.

This article is part of the Topical Collection on Pediatric Allergy and Immunology

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Hamad, A., Burks, W.A. Emerging Approaches to Food Desensitization in Children. Curr Allergy Asthma Rep 17, 32 (2017). https://doi.org/10.1007/s11882-017-0700-7

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  • DOI: https://doi.org/10.1007/s11882-017-0700-7

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