Oral Immunotherapy in Food Allergy: A Critical Pediatric Perspective

Abstract

There is evidence that in children with persistent IgE-mediated food allergy (FA) to cow's milk, hen's egg, and peanut, oral allergen-specific immunotherapy (OIT) may increase the reaction threshold to the culprit food allergen(s). OIT may protect patients from the occurrence of severe reactions in case of accidental ingestion of the culprit food during treatment. Notwithstanding, many gaps are still unsolved, including safety issues, identification of predictive biomarkers, and post-desensitization efficacy. In this perspective, the use of omalizumab (Anti-IgE monoclonal antibody) has been proposed as an adjunctive treatment to OIT in order to reduce the risk of allergic reactions related to OIT. This review aims to summarize the current evidence and unmet needs on OIT in children with FA to enhance the development of longitudinal, prospective, and well-designed studies able to fill the current gaps soon.

Current state and advances in desensitization for peanut allergy in pediatric age

“…15 Protocols for OIT in children with PA are heterogeneous: This is linked, for example, to the product type (e.g., defatted peanut flour, roasted, or boiled peanuts), duration, maintenance doses, primary endpoints, and safety profiles. 22,30 Several studies were conducted in the last decade. In the STOP II study, after 6 months of the maintenance dose of 800 mg of peanuts, 24 of 39 children (62%) passed the double-blind placebo-controlled food challenge (DBPCFC) taking 1.4 g of peanuts vs. zero patients in the control group, with a clinically meaningful increase in peanut threshold (p < .001).…”

“…15,39,40 Serious systemic adverse reactions, such as abdominal pain, vomiting, wheezing, urticaria, and anaphylaxis, usually occur during the build-up phase, but they may also occur during the maintenance phase at home. 15,22,30,39,40 Eosinophilic esophagitis was documented as a long-term adverse event, with an incidence of 0.3%. 22,26,30 Multiple cofactors (i.e., irregular intake, administration under fasting conditions, infections, exercise, use of other drugs, menstruation, uncontrolled asthma, and/or allergic rhinitis) increase the risk of adverse reactions.…”

“…15,22,30,39,40 Eosinophilic esophagitis was documented as a long-term adverse event, with an incidence of 0.3%. 22,26,30 Multiple cofactors (i.e., irregular intake, administration under fasting conditions, infections, exercise, use of other drugs, menstruation, uncontrolled asthma, and/or allergic rhinitis) increase the risk of adverse reactions. 22,30 Clinicians should inform families of therapy-related risks.…”

“…22,26,30 Multiple cofactors (i.e., irregular intake, administration under fasting conditions, infections, exercise, use of other drugs, menstruation, uncontrolled asthma, and/or allergic rhinitis) increase the risk of adverse reactions. 22,30 Clinicians should inform families of therapy-related risks. Several attempts are ongoing to improve the tolerability of OIT.…”

“…It is recommended in children with PA, with severe limitations in their QoL and the ineffectiveness of the exclusion diet 15 . Protocols for OIT in children with PA are heterogeneous: This is linked, for example, to the product type (e.g., defatted peanut flour, roasted, or boiled peanuts), duration, maintenance doses, primary endpoints, and safety profiles 22,30 . Several studies were conducted in the last decade.…”