New pharmaceutical approaches for the treatment of food allergies

Abstract

Allergic diseases constitute one of the most common causes of chronic illness in developed countries. The main mechanism determining allergy is an imbalance between Th1 and Th2 response towards Th2. Areas covered: This review describes the mechanisms underlying the natural tolerance to food components and the development of an allergic response in sensitized individuals. Furthermore, therapeutic approaches proposed to manage these abnormal immunologic responses food are also presented and discussed. Expert opinion: In the past, management of food allergies has consisted of the education of patients to avoid the ingestion of the culprit food and to initiate the therapy (e.g. self-injectable epinephrine) in case of accidental ingestion. In recent years, sublingual/oral immunotherapies based on the continuous administration of small amounts of the allergen have been developed. However, the long periods of time needed to obtain significant desensitization and the generation of adverse effects, limit their use. In order to solve these drawbacks, strategies to induce tolerance are being studied, such as the use of either adjuvant immunotherapy in order to facilitate the reversion of the Th2 response towards Th1 or the use of monoclonal antibodies to block the main immunogenic elements.

Immunological Changes Induced in Peach Allergy Patients with Systemic Reactions by Pru p 3 Sublingual Immunotherapy

“…Current treatment is based on the avoidance of peach, however this does not rule out the possibility of accidental ingestion . There is a clear need to develop safe and long‐term effective therapies for peach allergy …”

Pathogenic T cell subsets in allergic and chronic inflammatory bowel disorders

“…To date there is no established therapy for food allergy that specifically targets Th2 cells. Yet, major focuses of translational research in this area are immunomodulatory approaches to revert the Th2‐dominated immunological profile back into balance with Th1 cells as discussed above …”

“…Yet, major focuses of translational research in this area are immunomodulatory approaches to revert the Th2dominated immunological profile back into balance with Th1 cells as discussed above. 116 While there seems to be no significant contribution of Th2 cells to celiac disease and CD, their central role in UC is undisputed.…”

The slow progress in achieving an effective treatment for food allergy

“…However, such route of administration currently lacks demonstration of efficacy in controlled trials on food-allergic patients. New approaches for AIT include modification of the allergen molecules by chemical treatment or recombinant technology to lessen their reactivity with specific IgE, as well as the use of adjuvants allowing to decrease significantly the allergen doses [6]. Still, searching possible pitfalls in the trials performed thus far may help in understanding how to improve outcomes of AIT for food allergy.…”

“…The possible application of subcutaneous immunotherapy (SCIT) for food allergy was evaluated in 1992 in patients with peanut allergy, but the finding of a clinical efficacy was counterbalanced by an unacceptable rate of systemic, and also severe, adverse reactions [5]. This prevented the further use of food SCIT, and the subsequent investigations were based on other routes of administration, including oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and, more recently, epicutaneous immunotherapy (EPIT) [6]. However, to date no definite evidence of efficacy is available for any of these treatments, and this does not make them accepted in guidelines and consensus documents on AIT.…”