Immunological Outcomes of Allergen-Specific Immunotherapy in Food Allergy

Schoos, Ann‐Marie Malby; Bullens, Dominique; Chawes, Bo; Costa, Joana; Vlieger, Liselot De; DunnGalvin, Audrey; Epstein, Michelle M.; Garssen, Johan; Hilger, Christiane; Knipping, Karen; Kuehn, Annette; Mijakoski, Dragan; Munblit, Daniel; Nekliudov, Nikita A; Özdemir, Cevdet; Patient, Karine; Peroni, Diego; Stoleski, Sasho; Stylianou, Eva; Tukalj, Mirjana; Verhoeckx, Kitty; Zidarn, Mihaela; Veen, Willem van de

doi:10.3389/fimmu.2020.568598

Cited by 66 publications

(88 citation statements)

References 185 publications

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“…The presence of IgE and the titers of sIgE do not predict the severity of clinical reaction, but rather represent the reaction probability [72]. A transient early increase of IgE levels was observed during the first months of allergen immunotherapy, without an increase in allergic symptoms [28,44,72]. Prolonged immunotherapy leads to a decrease in IgE levels [73].…”

Section: Antibodiesmentioning

confidence: 99%

Hymenoptera Venom Immunotherapy: Immune Mechanisms of Induced Protection and Tolerance

Luzar

Korošec

Košnik

et al. 2021

Cells

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Hymenoptera venom allergy is one of the most severe allergic diseases, with a considerable prevalence of anaphylactic reaction, making it potentially lethal. In this review, we provide an overview of the current knowledge and recent findings in understanding induced immune mechanisms during different phases of venom immunotherapy. We focus on protection mechanisms that occur early, during the build-up phase, and on the immune tolerance, which occurs later, during and after Hymenoptera venom immunotherapy. The short-term protection seems to be established by the early desensitization of mast cells and basophils, which plays a crucial role in preventing anaphylaxis during the build-up phase of treatment. The early generation of blocking IgG antibodies seems to be one of the main reasons for the lower activation of effector cells. Long-term tolerance is reached after at least three years of venom immunotherapy. A decrease in basophil responsiveness correlates with tolerated sting challenge. Furthermore, the persistent decline in IgE levels and, by monitoring the cytokine profiles, a shift from a Th2 to Th1 immune response, can be observed. In addition, the generation of regulatory T and B cells has proven to be essential for inducing allergen tolerance. Most studies on the mechanisms and effectiveness data have been obtained during venom immunotherapy (VIT). Despite the high success rate of VIT, allergen tolerance may not persist for a prolonged time. There is not much known about immune mechanisms that assure long-term tolerance post-therapy.

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Section: Antibodiesmentioning

confidence: 99%

Hymenoptera Venom Immunotherapy: Immune Mechanisms of Induced Protection and Tolerance

Luzar

Korošec

Košnik

et al. 2021

Cells

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“…In addition, epithelial cells produce IL-25, IL-33, and thymic stromal lymphopoietin (TSLP), which can affect the Th2 responses [ 20 ]. These cytokines conditioned dendritic cells (DCs) and type 2 innate lymphoid cells (ILC2), leading to expansion and differentiation to Th2 cells [ 21 ], which produces Th2 cytokines [ 22 ], responsible for allergic processes ( Figure 1 A). During the successive allergen exposure, sIgE antibodies induce mast cell degranulation, release several pro-inflammatory mediators, including histamine, cytokines, and lipid mediators, promoting the Th2 response that is associated with allergic symptoms ( Figure 1 B).…”

Section: Mechanisms In Famentioning

confidence: 99%

New Insights in Therapy for Food Allergy

Mayorga

Palomares

Cañas

et al. 2021

Foods

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Food allergy is an increasing problem worldwide, with strict avoidance being classically the only available reliable treatment. The main objective of this review is to cover the latest information about the tools available for the diagnosis and treatment of food allergies. In recent years, many efforts have been made to better understand the humoral and cellular mechanisms involved in food allergy and to improve the strategies for diagnosis and treatment. This review illustrates IgE-mediated food hypersensitivity and provides a current description of the diagnostic strategies and advances in different treatments. Specific immunotherapy, including different routes of administration and new therapeutic approaches, such as hypoallergens and nanoparticles, are discussed in detail. Other treatments, such as biologics and microbiota, are also described. Therefore, we conclude that although important efforts have been made in improving therapies for food allergies, including innovative approaches mainly focusing on efficacy and safety, there is an urgent need to develop a set of basic and clinical results to help in the diagnosis and treatment of food allergies.

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“…OIT efficacy/effectiveness is presumably dependent on its effects on the allergen-specific immune response ( 47 , 48 ). The immunological basis underlying desensitization and SU during OIT are still poorly understood.…”

Section: Efficacy and Effectivenessmentioning

confidence: 99%

“…IgG 4 has been the most studied sIg in OIT, but other subclasses may contribute to the overall blocking and inhibitory sIgG response in FA ( 50 ). Considering cellular immunity, the spotlight has mainly been on Treg cells, which typically increase during OIT and exert a beneficial, but transient, immunosuppressive function ( 48 ). Therefore, while there is evidence that OIT induces protective immunological mechanisms ( 47 , 48 , 50 ), our understanding of these circuits is still fairly limited, and therapeutic approaches to make them endure after OIT interruption remain to be clarified ( 49 ).…”

Section: Efficacy and Effectivenessmentioning

confidence: 99%

“…The suppression of the immunologic response during OIT seems to be transient ( 80 , 81 ) and unable to control persistent populations of pathogenic Th2-cells, which have been detected in patients with peanut allergy after 12 to 24 months of OIT ( 80 ). Hence it is unclear if immunological markers can serve as a practical and reliable outcome of OIT ( 48 ). A detailed characterization of the immune cells affected by OIT is required to uncover immunological changes indicative of durable SU or effective desensitization, which can be tracked after OIT discontinuation ( 48 , 49 , 77 ).…”

Section: Efficacy and Effectivenessmentioning

confidence: 99%

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Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

et al. 2021

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The prevalence of food allergy has increased in recent years, especially in children. Allergen avoidance, and drugs in case of an allergic reaction, remains the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanut, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization through the consumption of an increasing amount of a food allergen, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current pediatric OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, pediatric OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.

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Immunological Outcomes of Allergen-Specific Immunotherapy in Food Allergy

Cited by 66 publications

References 185 publications

Hymenoptera Venom Immunotherapy: Immune Mechanisms of Induced Protection and Tolerance

Hymenoptera Venom Immunotherapy: Immune Mechanisms of Induced Protection and Tolerance

New Insights in Therapy for Food Allergy

Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

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