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Although oral immunotherapy (OIT) for food allergy is effective at inducing desensitization, it seems to have a limited ability to induce tolerance and is associated with high rates of adverse reactions.
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Use of an adjuvant with food immunotherapy may reduce adverse reactions and/or enhance tolerance induction (also referred to as sustained unresponsiveness).
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Adjuvants like anti–immunoglobulin E monoclonal antibody and interferon-gamma improve tolerability of OIT by reducing adverse reactions,
Adjuvant Therapies in Food Immunotherapy
Section snippets
Key points
Identifying an optimal outcome: desensitization versus sustained unresponsiveness
Potential food allergy treatments can offer 2 possible outcomes: desensitization or tolerance. Desensitization is defined as an increase in the threshold for reaction and requires continued regular allergen exposure.4 This clinical unresponsiveness is temporary and lasts only while allergen ingestion is maintained. Tolerance is the state of prolonged immune unresponsiveness that persists after withdrawal of the allergen for a period of several weeks or months. There is currently no consensus on
Limitations of oral immunotherapy as a potential treatment of food allergy
Cumulative evidence confirms that OIT is effective at inducing desensitization in most peanut, egg, and milk allergic patients8, 9; however, SU is only achieved in about a third of patients following peanut, egg, or milk OIT.8 Furthermore, OIT-induced SU seems to be short-lived, with 50% of subjects who achieved SU at 3 months after peanut OIT losing SU by 6 months after treatment.10, 11 Suppression of the allergen-specific immunologic response similarly seems to be transient.12
Adverse events
Adjuvant therapies
One approach to reduce OIT-associated adverse reactions and/or enhance the tolerogenic effects of OIT is the use of an adjuvant together with food immunotherapy. Adjuvants may be selected for their ability to suppress the acute allergic reaction and/or modulate the underlying allergic immune response, respectively.
Future considerations and summary
Considering the significant impact of food allergy on individuals and society, finding a therapy that can alter the natural course of disease is a major priority. Although OIT can induce desensitization in a high proportion of treated patients, studies suggest it is less effective at inducing SU. Moreover, OIT is associated with frequent adverse effects. Anti-IgE mAb administered together with OIT improved the tolerability of OIT by reducing adverse reactions and increasing the likelihood for
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Cited by (20)
Food oral immunotherapy: Why use a biologic?
2023, Revue Francaise d'AllergologieProbiotic peanut oral immunotherapy versus oral immunotherapy and placebo in children with peanut allergy in Australia (PPOIT-003): a multicentre, randomised, phase 2b trial
2022, The Lancet Child and Adolescent HealthCitation Excerpt :As children aged younger than 5 years have limited ability to articulate feeling pain or distress,31 a treatment that reduces gastrointestinal adverse events, even to a modest degree, would be beneficial. Studies evaluating the use of adjuvants alongside food OIT to reduce adverse reactions and enhance efficacy are underway (NCT03682770, NCT03881696).32 Addition of a probiotic offers a simple, low-cost approach to reduce adverse events associated with OIT in young children.
Determinants of omalizumab dose–related efficacy in oral immunotherapy: Evidence from a cohort of 181 patients
2021, Journal of Allergy and Clinical ImmunologyPeanut Oral Immunotherapy: State of the Art
2020, Immunology and Allergy Clinics of North AmericaCitation Excerpt :DS is defined as an increase in the reaction eliciting threshold dose to the allergen while receiving active treatment.2 This is a temporary state of protection that is only maintained while regular OIT dosing is continued (usually daily) and protection is lost rapidly (within 1–2 weeks) on discontinuation of regular allergen exposure.3 Sustained unresponsiveness (SU) is a long-lasting state of nonreactivity to the food allergen that persists weeks or months after cessation of OIT.2
Development of probiotic-loaded microcapsules for local delivery: Physical properties, cell release and growth
2018, European Journal of Pharmaceutical SciencesCitation Excerpt :The alginate microcapsules thus allow sufficient exchange of nutrients, oxygen and biologically active products (antimicrobials) to support the successful revival of these probiotic bacteria after their rehydration. As well as their potential use in the treatment of periodontal disease, there are other health issues where such targeted and local probiotic delivery can benefit patients, such as for cystic fibrosis (Van Biervliet et al., 2017), bacterial vaginosis (Huang et al., 2014), allergic reactions (Loh and Tang, 2018), and necrotising enterocolitis. Therefore, this proposed probiotic delivery system has the potential to also be used for other types of probiotics, and in the treatment of several diseases.
Prospects for developing allergen-depleted food crops
2023, Plant Genome
M. Tang is a member of Nestle Nutrition Institute Medical Advisory Board Oceania and an employee of and has share options/interest in ProTa Therapeutics. W. Loh has no potential conflicts of interest to disclose.