Skip to main content
Top
Published in: Clinical Reviews in Allergy & Immunology 2/2018

01-10-2018

The Current State of Epicutaneous Immunotherapy for Food Allergy: a Comprehensive Review

Authors: Bruce J. Lanser, Donald Y. M. Leung

Published in: Clinical Reviews in Allergy & Immunology | Issue 2/2018

Login to get access

Abstract

The food allergy epidemic of recent years has led to the search for safe and effective methods of immunotherapy for foods. Studies of epicutaneous immunotherapy (EPIT) in mice have shown promising safety and efficacy data. Murine models have also identified probable mechanisms for the development of tolerance to food allergens, including the induction of regulatory T cells. Clinical data is lacking, but relatively small and early studies among peanut and cow’s milk allergic subjects suggest that EPIT has an excellent safety profile, particularly compared to other methods of specific allergen immunotherapy. Efficacy data are also promising for peanut allergy, among younger patients (ages 4–11 years of age), suggesting that a majority of young patients will experience an increase in reaction threshold with therapy. The goal of this therapy is the protection from accidental exposures to a known food allergen. Additional clinical data is needed to prove efficacy and further demonstrate the safety profile of EPIT for food allergy, prior to approval by the Food and Drug Administration.
Literature
1.
go back to reference Gupta RS et al (2011) The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics 128(1):e9–17CrossRef Gupta RS et al (2011) The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics 128(1):e9–17CrossRef
2.
go back to reference Sicherer SH et al (2010) US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 125(6):1322–1326CrossRef Sicherer SH et al (2010) US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 125(6):1322–1326CrossRef
3.
go back to reference Sampson HA et al (2014) Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 134(5):1016–25.e43CrossRef Sampson HA et al (2014) Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 134(5):1016–25.e43CrossRef
4.
go back to reference Fong AT, Katelaris CH, Wainstein B (2017) Bullying and quality of life in children and adolescents with food allergy. J Paediatr Child Health 53(7):630–635CrossRef Fong AT, Katelaris CH, Wainstein B (2017) Bullying and quality of life in children and adolescents with food allergy. J Paediatr Child Health 53(7):630–635CrossRef
5.
go back to reference Vallery-Radot P, Hangenau J (1921) Essai de désensibilisation par des cutiréactions répétées. Bull Soc Méd Hôp Paris 45:1251–1260 Vallery-Radot P, Hangenau J (1921) Essai de désensibilisation par des cutiréactions répétées. Bull Soc Méd Hôp Paris 45:1251–1260
6.
go back to reference Pautrizel R et al (1957) Allergenic group specificity & therapeutic consequences in asthma; specific desensitization method by epicutaneous route. Sem Hop 33(22):1394–1403PubMed Pautrizel R et al (1957) Allergenic group specificity & therapeutic consequences in asthma; specific desensitization method by epicutaneous route. Sem Hop 33(22):1394–1403PubMed
7.
go back to reference Dioszeghy V et al (2011) Epicutaneous immunotherapy results in rapid allergen uptake by dendritic cells through intact skin and downregulates the allergen-specific response in sensitized mice. J Immunol 186(10):5629–5637CrossRef Dioszeghy V et al (2011) Epicutaneous immunotherapy results in rapid allergen uptake by dendritic cells through intact skin and downregulates the allergen-specific response in sensitized mice. J Immunol 186(10):5629–5637CrossRef
8.
go back to reference Jones SM et al (2017) Epicutaneous immunotherapy for the treatment of peanut allergy in children and young adults. J Allergy Clin Immunol 139(4):1242–1252.e9CrossRef Jones SM et al (2017) Epicutaneous immunotherapy for the treatment of peanut allergy in children and young adults. J Allergy Clin Immunol 139(4):1242–1252.e9CrossRef
9.
go back to reference Mondoulet L et al (2010) Epicutaneous immunotherapy on intact skin using a new delivery system in a murine model of allergy. Clin Exp Allergy 40(4):659–667CrossRef Mondoulet L et al (2010) Epicutaneous immunotherapy on intact skin using a new delivery system in a murine model of allergy. Clin Exp Allergy 40(4):659–667CrossRef
10.
go back to reference Mondoulet L et al (2011) Epicutaneous immunotherapy using a new epicutaneous delivery system in mice sensitized to peanuts. Int Arch Allergy Immunol 154(4):299–309CrossRef Mondoulet L et al (2011) Epicutaneous immunotherapy using a new epicutaneous delivery system in mice sensitized to peanuts. Int Arch Allergy Immunol 154(4):299–309CrossRef
11.
go back to reference Mondoulet L et al (2012) Epicutaneous immunotherapy compared with sublingual immunotherapy in mice sensitized to pollen (Phleum pratense). ISRN Allergy 2012:375735CrossRef Mondoulet L et al (2012) Epicutaneous immunotherapy compared with sublingual immunotherapy in mice sensitized to pollen (Phleum pratense). ISRN Allergy 2012:375735CrossRef
12.
go back to reference Hadis U et al (2011) Intestinal tolerance requires gut homing and expansion of FoxP3+ regulatory T cells in the lamina propria. Immunity 34(2):237–246CrossRef Hadis U et al (2011) Intestinal tolerance requires gut homing and expansion of FoxP3+ regulatory T cells in the lamina propria. Immunity 34(2):237–246CrossRef
13.
go back to reference Akdis CA, Akdis M (2009) Mechanisms and treatment of allergic disease in the big picture of regulatory T cells. J Allergy Clin Immunol 123(4):735–746 quiz 747-8CrossRef Akdis CA, Akdis M (2009) Mechanisms and treatment of allergic disease in the big picture of regulatory T cells. J Allergy Clin Immunol 123(4):735–746 quiz 747-8CrossRef
14.
go back to reference Dioszeghy V et al (2014) The regulatory T cells induction by epicutaneous immunotherapy is sustained and mediates long-term protection from eosinophilic disorders in peanut-sensitized mice. Clin Exp Allergy 44(6):867–881CrossRef Dioszeghy V et al (2014) The regulatory T cells induction by epicutaneous immunotherapy is sustained and mediates long-term protection from eosinophilic disorders in peanut-sensitized mice. Clin Exp Allergy 44(6):867–881CrossRef
15.
go back to reference Dioszeghy V et al (2017) Crucial role of Langerhans cells in epicutaneous immunotherapy. Allergy 72(S103):155 Dioszeghy V et al (2017) Crucial role of Langerhans cells in epicutaneous immunotherapy. Allergy 72(S103):155
16.
go back to reference Pajno GB et al (2001) Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study. Clin Exp Allergy 31(9):1392–1397CrossRef Pajno GB et al (2001) Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study. Clin Exp Allergy 31(9):1392–1397CrossRef
17.
go back to reference Purello-D'Ambrosio F et al (2001) Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not. A retrospective study. Clin Exp Allergy 31(8):1295–1302CrossRef Purello-D'Ambrosio F et al (2001) Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not. A retrospective study. Clin Exp Allergy 31(8):1295–1302CrossRef
18.
go back to reference Mondoulet L et al (2015) Specific epicutaneous immunotherapy prevents sensitization to new allergens in a murine model. J Allergy Clin Immunol 135(6):1546–1557 e4CrossRef Mondoulet L et al (2015) Specific epicutaneous immunotherapy prevents sensitization to new allergens in a murine model. J Allergy Clin Immunol 135(6):1546–1557 e4CrossRef
19.
go back to reference Tordesillas L et al (2017) Epicutaneous immunotherapy induces gastrointestinal LAP(+) regulatory T cells and prevents food-induced anaphylaxis. J Allergy Clin Immunol 139(1):189–201.e4CrossRef Tordesillas L et al (2017) Epicutaneous immunotherapy induces gastrointestinal LAP(+) regulatory T cells and prevents food-induced anaphylaxis. J Allergy Clin Immunol 139(1):189–201.e4CrossRef
20.
go back to reference Wavrin S et al (2017) Epicutaneous immunotherapy (EPIT) prevents anaphylaxis to egg in sensitized mice. Allergy 72(S103):156 Wavrin S et al (2017) Epicutaneous immunotherapy (EPIT) prevents anaphylaxis to egg in sensitized mice. Allergy 72(S103):156
21.
go back to reference Glenn GM et al (2007) Safety and immunogenicity of an enterotoxigenic Escherichia coli vaccine patch containing heat-labile toxin: use of skin pretreatment to disrupt the stratum corneum. Infect Immun 75(5):2163–2170CrossRef Glenn GM et al (2007) Safety and immunogenicity of an enterotoxigenic Escherichia coli vaccine patch containing heat-labile toxin: use of skin pretreatment to disrupt the stratum corneum. Infect Immun 75(5):2163–2170CrossRef
22.
go back to reference Frerichs DM et al (2008) Controlled, single-step, stratum corneum disruption as a pretreatment for immunization via a patch. Vaccine 26(22):2782–2787CrossRef Frerichs DM et al (2008) Controlled, single-step, stratum corneum disruption as a pretreatment for immunization via a patch. Vaccine 26(22):2782–2787CrossRef
23.
go back to reference Mondoulet L et al (2012) Intact skin and not stripped skin is crucial for the safety and efficacy of peanut epicutaneous immunotherapy (EPIT) in mice. Clin Transl Allergy 2(1):22CrossRef Mondoulet L et al (2012) Intact skin and not stripped skin is crucial for the safety and efficacy of peanut epicutaneous immunotherapy (EPIT) in mice. Clin Transl Allergy 2(1):22CrossRef
24.
go back to reference Wavrin S et al (2016) No impact of filaggrin deficiency on Epit efficacy in a murine model. J Allergy Clin Immunol 137(2S):AB133CrossRef Wavrin S et al (2016) No impact of filaggrin deficiency on Epit efficacy in a murine model. J Allergy Clin Immunol 137(2S):AB133CrossRef
25.
go back to reference von Moos S et al (2014) Comparing safety of abrasion and tape-stripping as skin preparation in allergen-specific epicutaneous immunotherapy. J Allergy Clin Immunol 134(4):965–7.e4CrossRef von Moos S et al (2014) Comparing safety of abrasion and tape-stripping as skin preparation in allergen-specific epicutaneous immunotherapy. J Allergy Clin Immunol 134(4):965–7.e4CrossRef
26.
go back to reference Akei HS et al (2005) Epicutaneous antigen exposure primes for experimental eosinophilic esophagitis in mice. Gastroenterology 129(3):985–994CrossRef Akei HS et al (2005) Epicutaneous antigen exposure primes for experimental eosinophilic esophagitis in mice. Gastroenterology 129(3):985–994CrossRef
27.
go back to reference Mondoulet L et al (2012) Epicutaneous immunotherapy (EPIT) blocks the allergic esophago-gastro-enteropathy induced by sustained oral exposure to peanuts in sensitized mice. PLoS One 7(2):e31967CrossRef Mondoulet L et al (2012) Epicutaneous immunotherapy (EPIT) blocks the allergic esophago-gastro-enteropathy induced by sustained oral exposure to peanuts in sensitized mice. PLoS One 7(2):e31967CrossRef
28.
go back to reference Lucendo AJ, Arias A, Tenias JM (2014) Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 113(6):624–629CrossRef Lucendo AJ, Arias A, Tenias JM (2014) Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 113(6):624–629CrossRef
29.
go back to reference Dupont C et al (2010) Cow’s milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol 125(5):1165–1167CrossRef Dupont C et al (2010) Cow’s milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol 125(5):1165–1167CrossRef
30.
go back to reference Karine, R., et al., Safety of Viaskin milk epicutaneous immunotherapy (EPIT) in IgE-mediated cow’s milk allergy (CMA) in children (MILES Study). 2016. 137(2, Supplement): p. AB132 Karine, R., et al., Safety of Viaskin milk epicutaneous immunotherapy (EPIT) in IgE-mediated cow’s milk allergy (CMA) in children (MILES Study). 2016. 137(2, Supplement): p. AB132
31.
go back to reference Jones SM et al (2016) Safety of epicutaneous immunotherapy for the treatment of peanut allergy: A phase 1 study using the Viaskin patch. J Allergy Clin Immunol 137(4):1258–61.e1–10CrossRef Jones SM et al (2016) Safety of epicutaneous immunotherapy for the treatment of peanut allergy: A phase 1 study using the Viaskin patch. J Allergy Clin Immunol 137(4):1258–61.e1–10CrossRef
32.
go back to reference Sampson HA et al (2016) Enhanced efficacy and confirmed safety of a two-year epicutaneous immunotherapy (EPIT) treatment of peanut allergy with Viaskin peanut: the continuation of the Vipes phase IIb randomized controlled trial (RCT). J Allergy Clin Immunol 137(2S):AB408CrossRef Sampson HA et al (2016) Enhanced efficacy and confirmed safety of a two-year epicutaneous immunotherapy (EPIT) treatment of peanut allergy with Viaskin peanut: the continuation of the Vipes phase IIb randomized controlled trial (RCT). J Allergy Clin Immunol 137(2S):AB408CrossRef
33.
go back to reference Sampson HA et al (2015) 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 135(2S):AB390CrossRef Sampson HA et al (2015) 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 135(2S):AB390CrossRef
34.
go back to reference Wood RA (2016) Food allergen immunotherapy: current status and prospects for the future. J Allergy Clin Immunol 137(4):973–982CrossRef Wood RA (2016) Food allergen immunotherapy: current status and prospects for the future. J Allergy Clin Immunol 137(4):973–982CrossRef
35.
go back to reference Gernez Y, Nowak-Wegrzyn A (2017) Immunotherapy for food allergy: are we there yet? J Allergy Clin Immunol Pract 5(2):250–272CrossRef Gernez Y, Nowak-Wegrzyn A (2017) Immunotherapy for food allergy: are we there yet? J Allergy Clin Immunol Pract 5(2):250–272CrossRef
36.
go back to reference Dupont C et al (2009) Epicutaneous immunotherapy in severe cow milk allergy: a double blind pilot trial. J Allergy Clin Immunol 123(2S):S183CrossRef Dupont C et al (2009) Epicutaneous immunotherapy in severe cow milk allergy: a double blind pilot trial. J Allergy Clin Immunol 123(2S):S183CrossRef
37.
go back to reference Koppelman S et al (2017) Epicutaneous immunotherapy (EPIT) for peanut allergy modifies IgG4 responses to major peanut allergens. Allergy 72(S103):737 Koppelman S et al (2017) Epicutaneous immunotherapy (EPIT) for peanut allergy modifies IgG4 responses to major peanut allergens. Allergy 72(S103):737
38.
go back to reference Dupont C et al (2014) Peanut epicutaneous immunotherapy (EPIT) in peanut-allergic children: 18 months treatment in the Arachild Study. J Allergy Clin Immunol 133(2S):AB102CrossRef Dupont C et al (2014) Peanut epicutaneous immunotherapy (EPIT) in peanut-allergic children: 18 months treatment in the Arachild Study. J Allergy Clin Immunol 133(2S):AB102CrossRef
39.
go back to reference Togias A et al (2017) Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol 139(1):29–44CrossRef Togias A et al (2017) Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol 139(1):29–44CrossRef
40.
go back to reference Peters RL et al (2014) The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study. J Allergy Clin Immunol 133(2):485–491CrossRef Peters RL et al (2014) The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study. J Allergy Clin Immunol 133(2):485–491CrossRef
41.
go back to reference Freier S, Kletter B (1970) Milk allergy in infants and young children. Current knowledge. Clin Pediatr (Phila) 9(8):449–454CrossRef Freier S, Kletter B (1970) Milk allergy in infants and young children. Current knowledge. Clin Pediatr (Phila) 9(8):449–454CrossRef
42.
go back to reference Nelson HS et al (1997) Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol 99(6 Pt 1):744–751CrossRef Nelson HS et al (1997) Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol 99(6 Pt 1):744–751CrossRef
Metadata
Title
The Current State of Epicutaneous Immunotherapy for Food Allergy: a Comprehensive Review
Authors
Bruce J. Lanser
Donald Y. M. Leung
Publication date
01-10-2018
Publisher
Springer US
Published in
Clinical Reviews in Allergy & Immunology / Issue 2/2018
Print ISSN: 1080-0549
Electronic ISSN: 1559-0267
DOI
https://doi.org/10.1007/s12016-017-8650-3

Other articles of this Issue 2/2018

Clinical Reviews in Allergy & Immunology 2/2018 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.