Immunotherapy of Food Allergy: a Comprehensive Review

Abstract

Food allergy imposes a severe global health burden, and thus, there is a dire need for safe and effective treatments. Allergen-specific immunotherapy (AIT) is currently the only approach to restore immune tolerance through administrating increasing doses of allergen extracts. Unfortunately, the development of AIT for food allergies has been impeded by the frequent anaphylactic side effects during the course of treatment. The emergence of component-resolved diagnosis has greatly improved our ability to identify causative allergens and revolutionized the design of AIT. Molecular features such as IgE-binding epitopes and T cell epitopes have been elucidated in most major food allergens, inspiring the use of multiple strategies to manipulate the allergens and design safer alternatives to AIT. Although these allergen-modifying approaches are currently restricted to preclinical characterization and animal studies, the employment of these strategies has certainly paved the way for improving the safety of existing AIT. A safe and effective AIT for food allergy is not far beyond reach.

Overcoming Shellfish Allergy: How Far Have We Come?

“…In cow's milk, egg and peanut allergies, there is extensive literature on the clinical efficacies of different OIT, SLIT and EPIT regimens [50,97], as well as novel pioneering studies on diagnostic and AIT strategies. The FAST project aiming at testing hypoallergens against fish and peach allergies is actively underway [98].…”

Modulating Shrimp Tropomyosin-Mediated Allergy: Hypoallergen DNA Vaccines Induce Regulatory T Cells to Reduce Hypersensitivity in Mouse Model

“…Allergen-specific immunotherapy (AIT) is the only disease-modifying treatment that is currently available for respiratory allergies. However, AITs for IgE-mediated food allergies have significant efficacy limitations, associated side effects, debatable ability to achieve long-term protection following discontinuation of therapy, as well as adherence challenges [5,6,7,8,9,10]. No active immunotherapy for shellfish allergy is currently under investigation, even amidst the increasing prevalence of this type of food allergy.…”

Can alternative epitope mapping approaches increase the impact of B‐cell epitopes in food allergy diagnostics?

“…In contrast to allergy prediction, the impact of IgG‐, especially IgG 4 ‐ , binding epitopes in AIT monitoring has been investigated more intensively. In general, patients, irrespective of the AIT outcome, showed an increase in allergen‐specific IgG 4 levels as well as a temporary increase in IL‐10 secreting FoxP3‐positive Treg cells controlling a class switch to IgG 4 and a decrease in sIgE levels . In a peanut AIT trial, newly formed IgG 4 antibodies had specificities partly identical to identified IgE‐binding epitopes.…”

“…In general, patients, irrespective of the AIT outcome, showed an increase in allergen-specific IgG 4 levels as well as a temporary increase in IL-10 secreting FoxP3-positive Treg cells controlling a class switch to IgG 4 and a decrease in sIgE levels. [101][102][103][104] In a peanut AIT trial, newly formed IgG 4 antibodies had specificities partly identical to identified IgE-binding epitopes. Simultaneously, the total sIgE decreased, although, as also shown in CMA AIT trials, new IgE specificities were developed.…”