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Current Allergy and Asthma Reports
Published in: Current Allergy and Asthma Reports 5/2017

01-05-2017 | Pediatric Allergy and Immunology (W Dolen, Section Editor)

Emerging Approaches to Food Desensitization in Children

Authors: Ahmad Hamad, Wesley A. Burks

Published in: Current Allergy and Asthma Reports | Issue 5/2017

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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.
Literature
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 CrossRefPubMedPubMedCentral
3.
Kattan J. The prevalence and natural history of food allergy. Current Allergy and Asthma Reports. 2016;16(7):47.CrossRefPubMed
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. CrossRef
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.CrossRef
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.CrossRefPubMed
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 CrossRefPubMedPubMedCentral
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.CrossRefPubMed
9.
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.
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.CrossRef
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.CrossRefPubMedPubMedCentral
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.CrossRef
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.CrossRef
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.CrossRefPubMedPubMedCentral
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. CrossRefPubMed
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. CrossRefPubMed
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)
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.CrossRef
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 CrossRefPubMedPubMedCentral
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.CrossRefPubMed
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 CrossRefPubMedPubMedCentral
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 CrossRefPubMed
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 CrossRefPubMed
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.CrossRefPubMed
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.CrossRef
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 CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRef
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.CrossRefPubMedPubMedCentral
34.
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.CrossRefPubMed
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.CrossRef
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 CrossRefPubMed
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 CrossRefPubMedPubMedCentral
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.CrossRefPubMed
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.CrossRef
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 CrossRef
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.CrossRef
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.CrossRef
Metadata
Title
Emerging Approaches to Food Desensitization in Children
Authors
Ahmad Hamad
Wesley A. Burks
Publication date
01-05-2017
Publisher
Springer US
Published in
Current Allergy and Asthma Reports / Issue 5/2017
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-017-0700-7

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