Adjuvant Therapies in Food Immunotherapy

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Key points

  • 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.

  • Use of an adjuvant with food immunotherapy may reduce adverse reactions and/or enhance tolerance induction (also referred to as sustained unresponsiveness).

  • Adjuvants like anti–immunoglobulin E monoclonal antibody and interferon-gamma improve tolerability of OIT by reducing adverse reactions,

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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    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.

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