Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

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.
ADVANCED SEARCH
Log in
Top
Seminars in Immunopathology
Published in: Seminars in Immunopathology 5/2012

01-09-2012 | Review

The future of food allergy therapeutics

Authors: Michele Henson, A. Wesley Burks

Published in: Seminars in Immunopathology | Issue 5/2012

Login to get access

Abstract

Food allergy is increasing in prevalence in westernized countries, leading to significant morbidity including nutritional deficiencies and growth delay as well as psychosocial burdens and the potential for fatal anaphylaxis. There is currently no effective form of therapy, and the mainstay of treatment remains strict avoidance. However, there are a number of promising therapeutic strategies currently being investigated for the treatment of food allergies. Allergen-specific approaches, such as various forms of immunotherapy, have been a major focus of investigation and appear to be promising methods of desensitization. More recently, the addition of anti-IgE monoclonal antibodies (mAbs) to immunotherapy regimens has been studied. Early work with antigen-fixed leukocytes in a murine model has shown promise in inducing tolerance, as have vaccines containing modified recombinant food proteins coadministered with heat-killed Escherichia coli. Nonspecific approaches include a Chinese herbal formulation, anti-IgE mAbs, and Trichuris suis ova therapy. The array of treatment modalities currently being investigated increases the likelihood of finding one or more effective therapies for the treatment of food allergy.
Literature
1.
Branum AM, Lukacs SL (2009) Food allergy among children in the United States. Pediatrics 124(6):1549–1555PubMedCrossRef
2.
Rona RJ et al (2007) The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol 120(3):638–646PubMedCrossRef
3.
Branum AM, Lukacs SL (2008) Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief. (10):1–8
4.
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):1322–1326PubMedCrossRef
5.
Sicherer SH, Sampson HA (2007) Peanut allergy: emerging concepts and approaches for an apparent epidemic. J Allergy Clin Immunol 120(3):491–503, quiz 504-5PubMedCrossRef
6.
Decker WW et al (2008) The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol 122(6):1161–1165PubMedCrossRef
7.
8.
Bock SA, Munoz-Furlong A, Sampson HA (2007) Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol 119(4):1016–1018PubMedCrossRef
9.
Christie L et al (2002) Food allergies in children affect nutrient intake and growth. J Am Diet Assoc 102(11):1648–1651PubMedCrossRef
10.
Mennella JA, Ventura AK, Beauchamp GK (2011) Differential growth patterns among healthy infants fed protein hydrolysate or cow-milk formulas. Pediatrics 127(1):110–118PubMedCrossRef
11.
Lieberman JA, Sicherer SH (2011) Quality of life in food allergy. Curr Opin Allergy Clin Immunol 11(3):236–242PubMedCrossRef
12.
Flokstra-de Blok BM et al (2010) Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires. Allergy 65(8):1031–1038PubMedCrossRef
13.
Lieberman JA et al (2010) Bullying among pediatric patients with food allergy. Ann Allergy Asthma Immunol 105(4):282–286PubMedCrossRef
14.
Boyce JA et al (2010) Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 126(6 Suppl):S1–S58PubMed
15.
Burks AW et al (2011) NIAID-sponsored 2010 guidelines for managing food allergy: applications in the pediatric population. Pediatrics 128(5):955–965PubMedCrossRef
16.
Nowak-Wegrzyn A, Sampson HA (2011) Future therapies for food allergies. J Allergy Clin Immunol 127(3):558–573, quiz 574-5PubMedCrossRef
17.
Burks AW, Laubach S, Jones SM (2008) Oral tolerance, food allergy, and immunotherapy: implications for future treatment. J Allergy Clin Immunol 121(6):1344–1350PubMedCrossRef
18.
Chehade M, Mayer L (2005) Oral tolerance and its relation to food hypersensitivities. J Allergy Clin Immunol 115(1):3–12, quiz 13PubMedCrossRef
19.
20.
Untersmayr E, Jensen-Jarolim E (2008) The role of protein digestibility and antacids on food allergy outcomes. J Allergy Clin Immunol 121(6):1301–1308, quiz 1309-10PubMedCrossRef
21.
Pali-Scholl I et al (2008) Anti-acids lead to immunological and morphological changes in the intestine of BALB/c mice similar to human food allergy. Exp Toxicol Pathol 60(4–5):337–345PubMedCrossRef
22.
Groschwitz KR, Hogan SP (2009) Intestinal barrier function: molecular regulation and disease pathogenesis. J Allergy Clin Immunol 124(1):3–20, quiz 21-2PubMedCrossRef
23.
Manicassamy S et al (2010) Activation of beta-catenin in dendritic cells regulates immunity versus tolerance in the intestine. Science 329(5993):849–853PubMedCrossRef
24.
Navuluri L et al (2006) Allergic and anaphylactic response to sesame seeds in mice: identification of Ses i 3 and basic subunit of 11 s globulins as allergens. Int Arch Allergy Immunol 140(3):270–276PubMedCrossRef
25.
Fox AT et al (2009) Household peanut consumption as a risk factor for the development of peanut allergy. J Allergy Clin Immunol 123(2):417–423PubMedCrossRef
26.
Lack G (2012) Update on risk factors for food allergy. J Allergy Clin Immunol,
27.
Brown SJ et al (2011) Loss-of-function variants in the filaggrin gene are a significant risk factor for peanut allergy. J Allergy Clin Immunol 127(3):661–667PubMedCrossRef
28.
Vickery BP et al (2011) Mechanisms of immune tolerance relevant to food allergy. J Allergy Clin Immunol 127(3):576–584, quiz 585-6PubMedCrossRef
29.
Eifan AO, Shamji MH, Durham SR (2011) Long-term clinical and immunological effects of allergen immunotherapy. Curr Opin Allergy Clin Immunol 11(6):586–593PubMedCrossRef
30.
Patriarca G et al (2003) Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther 17(3):459–465PubMedCrossRef
31.
Varshney P et al (2011) A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol 127(3):654–660PubMedCrossRef
32.
Jones SM et al (2009) Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol 124(2):292–300, 300 e1-97PubMedCrossRef
33.
Kim EH et al (2011) Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol 127(3):640–646 e1PubMedCrossRef
34.
35.
Hunt KJ et al (1978) A controlled trial of immunotherapy in insect hypersensitivity. N Engl J Med 299(4):157–161PubMedCrossRef
36.
Oppenheimer JJ et al (1992) Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol 90(2):256–262PubMedCrossRef
37.
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):744–751PubMedCrossRef
38.
Land MH, Kim EH, Burks AW (2011) Oral desensitization for food hypersensitivity. Immunol Allergy Clin North Am 31(2):367–376, xiPubMedCrossRef
39.
Scurlock AM et al (2010) Pediatric food allergy and mucosal tolerance. Mucosal Immunol 3(4):345–354PubMedCrossRef
40.
41.
Patriarca C et al (1984) Oral specific hyposensitization in the management of patients allergic to food. Allergol Immunopathol (Madr) 12(4):275–281
42.
43.
Buchanan AD et al (2007) Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol 119(1):199–205PubMedCrossRef
44.
Staden U et al (2007) Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy 62(11):1261–1269PubMedCrossRef
45.
Longo G et al (2008) Specific oral tolerance induction in children with very severe cow’s milk-induced reactions. J Allergy Clin Immunol 121(2):343–347PubMedCrossRef
46.
Skripak JM et al (2008) A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow’s milk allergy. J Allergy Clin Immunol 122(6):1154–1160PubMedCrossRef
47.
Wood RA (2003) The natural history of food allergy. Pediatrics 111(6 Pt 3):1631–1637PubMed
48.
Fleischer DM (2007) The natural history of peanut and tree nut allergy. Curr Allergy Asthma Rep 7(3):175–181PubMedCrossRef
49.
Clark AT et al (2009) Successful oral tolerance induction in severe peanut allergy. Allergy 64(8):1218–1220PubMedCrossRef
50.
Nadeau KC et al (2012) Oral immunotherapy and anti-IgE antibody-adjunctive treatment for food allergy. Immunol Allergy Clin North Am 32(1):111–133PubMedCrossRef
51.
Blumchen K et al (2010) Oral peanut immunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol 126(1):83–91 e1PubMedCrossRef
52.
Fisher HR, Toit GD, Lack G (2011) Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance? Arch Dis Child 96(3):259–264PubMedCrossRef
53.
Thyagarajan A et al (2010) Peanut oral immunotherapy is not ready for clinical use. J Allergy Clin Immunol 126(1):31–32PubMedCrossRef
54.
Durham SR et al (2012) SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol 129(3):717–725 e5PubMedCrossRef
55.
Mempel M et al (2003) Severe anaphylaxis to kiwi fruit: immunologic changes related to successful sublingual allergen immunotherapy. J Allergy Clin Immunol 111(6):1406–1409PubMedCrossRef
56.
Enrique E et al (2005) Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. J Allergy Clin Immunol 116(5):1073–1079PubMedCrossRef
57.
Fernandez-Rivas M et al (2009) Randomized double-blind, placebo-controlled trial of sublingual immunotherapy with a Pru p 3 quantified peach extract. Allergy 64(6):876–883PubMedCrossRef
58.
Keet CA et al (2012) The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol 129(2):448–455.e5PubMedCrossRef
59.
Otsu K, Fleischer DM (2012) Therapeutics in food allergy: the current state of the art. Curr Allergy Asthma Rep 12(1):48–54PubMedCrossRef
60.
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):1165–1167PubMedCrossRef
61.
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):659–667PubMedCrossRef
62.
Mondoulet L et al (2011) Epicutaneous immunotherapy using a new epicutaneous delivery system in mice sensitized to peanuts. Int Arch Allergy Immunol 154(4):299–309PubMedCrossRef
63.
MacGlashan DW Jr et al (1997) Down-regulation of Fc(epsilon)RI expression on human basophils during in vivo treatment of atopic patients with anti-IgE antibody. J Immunol 158(3):1438–1445PubMed
64.
Pelaia G et al (2008) Omalizumab in the treatment of severe asthma: efficacy and current problems. Ther Adv Respir Dis 2(6):409–421PubMedCrossRef
65.
Leung DY et al (2003) Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med 348(11):986–993PubMedCrossRef
66.
Kuehr J et al (2002) Efficacy of combination treatment with anti-IgE plus specific immunotherapy in polysensitized children and adolescents with seasonal allergic rhinitis. J Allergy Clin Immunol 109(2):274–280PubMedCrossRef
67.
Casale TB et al (2006) Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis. J Allergy Clin Immunol 117(1):134–140PubMedCrossRef
68.
Nadeau KC et al (2011) Rapid oral desensitization in combination with omalizumab therapy in patients with cow’s milk allergy. J Allergy Clin Immunol 127(6):1622–1624PubMedCrossRef
69.
Hofmann AM et al (2009) Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol 124(2):286–291, 291 e1-6PubMedCrossRef
70.
Meglio P et al (2004) A protocol for oral desensitization in children with IgE-mediated cow’s milk allergy. Allergy 59(9):980–987PubMedCrossRef
71.
Smarr CB et al (2011) Antigen-fixed leukocytes tolerize Th2 responses in mouse models of allergy. J Immunol 187(10):5090–5098PubMedCrossRef
72.
Miller SD, Wetzig RP, Claman HN (1979) The induction of cell-mediated immunity and tolerance with protein antigens coupled to syngeneic lymphoid cells. J Exp Med 149(3):758–773PubMedCrossRef
73.
Luo X et al (2008) ECDI-fixed allogeneic splenocytes induce donor-specific tolerance for long-term survival of islet transplants via two distinct mechanisms. Proc Natl Acad Sci U S A 105(38):14527–14532PubMedCrossRef
74.
Li XM et al (2003) Persistent protective effect of heat-killed Escherichia coli producing “engineered”, recombinant peanut proteins in a murine model of peanut allergy. J Allergy Clin Immunol 112(1):159–167PubMedCrossRef
75.
Li XM et al (2003) Engineered recombinant peanut protein and heat-killed Listeria monocytogenes coadministration protects against peanut-induced anaphylaxis in a murine model. J Immunol 170(6):3289–3295PubMed
76.
Chan CK et al (2006) Ding Chuan Tang, a Chinese herb decoction, could improve airway hyper-responsiveness in stabilized asthmatic children: a randomized, double-blind clinical trial. Pediatr Allergy Immunol 17(5):316–322PubMedCrossRef
77.
Chang TT, Huang CC, Hsu CH (2006) Clinical evaluation of the Chinese herbal medicine formula STA-1 in the treatment of allergic asthma. Phytother Res 20(5):342–347PubMedCrossRef
78.
Hsu CH, Lu CM, Chang TT (2005) Efficacy and safety of modified Mai-Men-Dong-Tang for treatment of allergic asthma. Pediatr Allergy Immunol 16(1):76–81PubMedCrossRef
79.
Kao ST et al (2000) The effect of Chinese herbal medicine, xiao-qing-long tang (XQLT), on allergen-induced bronchial inflammation in mite-sensitized mice. Allergy 55(12):1127–1133PubMedCrossRef
80.
Li XM, Brown L (2009) Efficacy and mechanisms of action of traditional Chinese medicines for treating asthma and allergy. J Allergy Clin Immunol 123(2):297–306, quiz 307-8PubMedCrossRef
81.
Bensky DBR (1990) Chinese herbal medicine: formulas & strategies. Eastland: Seattle.
82.
Qu C et al (2007) Induction of tolerance after establishment of peanut allergy by the food allergy herbal formula-2 is associated with up-regulation of interferon-gamma. Clin Exp Allergy 37(6):846–855PubMedCrossRef
83.
Srivastava KD et al (2005) The Chinese herbal medicine formula FAHF-2 completely blocks anaphylactic reactions in a murine model of peanut allergy. J Allergy Clin Immunol 115(1):171–178PubMedCrossRef
84.
Srivastava KD et al (2009) Food Allergy Herbal Formula-2 silences peanut-induced anaphylaxis for a prolonged posttreatment period via IFN-gamma-producing CD8+ T cells. J Allergy Clin Immunol 123(2):443–451PubMedCrossRef
85.
Patil SP et al (2011) Clinical safety of Food Allergy Herbal Formula-2 (FAHF-2) and inhibitory effect on basophils from patients with food allergy: extended phase I study. J Allergy Clin Immunol 128(6):1259–1265 e2PubMedCrossRef
86.
Song Y et al (2010) Food allergy herbal formula 2 protection against peanut anaphylactic reaction is via inhibition of mast cells and basophils. J Allergy Clin Immunol 126(6):1208–1217 e3PubMedCrossRef
87.
Wang J et al (2010) Safety, tolerability, and immunologic effects of a food allergy herbal formula in food allergic individuals: a randomized, double-blinded, placebo-controlled, dose escalation, phase 1 study. Ann Allergy Asthma Immunol 105(1):75–84PubMedCrossRef
88.
Sampson HA et al (2011) A phase II, randomized, double-blind, parallel-group, placebo-controlled oral food challenge trial of Xolair (omalizumab) in peanut allergy. J Allergy Clin Immunol 127(5):1309–1310 e1PubMedCrossRef
89.
Medeiros M Jr et al (2003) Schistosoma mansoni infection is associated with a reduced course of asthma. J Allergy Clin Immunol 111(5):947–951PubMedCrossRef
90.
Bashir ME et al (2002) An enteric helminth infection protects against an allergic response to dietary antigen. J Immunol 169(6):3284–3292PubMed
Metadata
Title
The future of food allergy therapeutics
Authors
Michele Henson
A. Wesley Burks
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
Seminars in Immunopathology / Issue 5/2012
Print ISSN: 1863-2297
Electronic ISSN: 1863-2300
DOI
https://doi.org/10.1007/s00281-012-0319-7

Other articles of this Issue 5/2012

Seminars in Immunopathology 5/2012 Go to the issue

Review

Immunological mechanisms for desensitization and tolerance in food allergy

Review

Food-induced anaphylaxis: mast cells as modulators of anaphylactic severity

Review

Mucosal antibodies in the regulation of tolerance and allergy to foods

Review

Microbial regulation of allergic responses to food

Review

Eosinophilic gastrointestinal diseases—clinically diverse and histopathologically confounding

Review

Innate immunostimulatory properties of allergens and their relevance to food allergy
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

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

Pediatric Cardiology Video

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

Cardiopulmonary Comorbidity Video

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

Valvular Heart Disease Video

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

Heart Failure Video

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

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

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

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits