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Current Allergy and Asthma Reports

Erschienen in:

01.06.2015 | Immunotherapy and Immunomodulators (B Vickery, Section Editor)

An Examination of Clinical and Immunologic Outcomes in Food Allergen Immunotherapy by Route of Administration

verfasst von: David Chiang, M. Cecilia Berin

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 6/2015

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Abstract

Allergen immunotherapy for the treatment of food allergy has been a subject of intensive study within the last 10 years. After an unsuccessful attempt with subcutaneous immunotherapy for peanut allergy, other routes with varying degrees of safety and efficacy have been tested for peanut, milk, and egg allergies. In this review, we summarize the results to date with oral immunotherapy, sublingual immunotherapy, and epicutaneous immunotherapy for the treatment of food allergy. While results of immunotherapy trials are promising, increases in efficacy are commonly associated with an increased side effect profile. There is a need for additional research beginning at the preclinical level to develop safe and effective treatments for food allergy.

Fleischer DM, Perry TT, Atkins D, Wood RA, Burks AW, Jones SM, et al. Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study. Pediatrics. 2012;130(1):e25–32. doi:10.1542/peds.2011-1762.PubMedCentralPubMedCrossRef

Sicherer SH, Noone SA, Munoz-Furlong A. The impact of childhood food allergy on quality of life. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2001;87(6):461–4. doi:10.1016/S1081-1206(10)62258-2.CrossRef

Nelson HS, Lahr J, Rule R, Bock A, Leung D. Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol. 1997;99(6 Pt 1):744–51.PubMedCrossRef

Oppenheimer JJ, Nelson HS, Bock SA, Christensen F, Leung DY. Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol. 1992;90(2):256–62.PubMedCrossRef

Schofield A. A case of egg poisoning. Lancet. 1908;171(4410):716. doi:10.1016/S0140-6736(00)67313-0.CrossRef

Edwards HE. Oral desensitization in food allergy. Can Med Assoc J. 1940;43(3):234–6.PubMedCentralPubMed

Patriarca G, Schiavino D, Nucera E, Schinco G, Milani A, Gasbarrini GB. Food allergy in children: results of a standardized protocol for oral desensitization. Hepato-Gastroenterology. 1998;45(19):52–8.PubMed

8.•

Narisety SD, Frischmeyer-Guerrerio PA, Keet CA, Gorelik M, Schroeder J, Hamilton RG, et al. A randomized, double-blind, placebo-controlled pilot study of sublingual versus oral immunotherapy for the treatment of peanut allergy. J Allergy Clin Immunol. 2014. doi:10.1016/j.jaci.2014.11.005. A direct comparison of the efficacy of SLIT and OIT for the treatment of peanut allergy.

Jones SM, Pons L, Roberts JL, Scurlock AM, Perry TT, Kulis M, et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol. 2009;124(2):292–300. doi:10.1016/j.jaci.2009.05.022.PubMedCentralPubMedCrossRef

10.•

Vickery BP, Scurlock AM, Kulis M, Steele PH, Kamilaris J, Berglund JP, et al. Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy. J Allergy Clin Immunol. 2014;133(2):468–75. doi:10.1016/j.jaci.2013.11.007. A long-term follow up of subjects receiving peanut OIT up to five years, with assessment of maintenance of tolerance to peanut after discontinuation of OIT.PubMedCentralPubMedCrossRef

11.

Blumchen K, Ulbricht H, Staden U, Dobberstein K, Beschorner J, de Oliveira LC, et al. Oral peanut immunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol. 2010;126(1):83–91. doi:10.1016/j.jaci.2010.04.030.PubMedCrossRef

12.

Varshney P, Jones SM, Scurlock AM, Perry TT, Kemper A, Steele P, et al. A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol. 2011;127(3):654–60. doi:10.1016/j.jaci.2010.12.1111.PubMedCentralPubMedCrossRef

13.••

Burks AW, Jones SM, Wood RA, Fleischer DM, Sicherer SH, Lindblad RW, et al. Oral immunotherapy for treatment of egg allergy in children. N Engl J Med. 2012;367(3):233–43. doi:10.1056/NEJMoa1200435. A landmark multi-center double-blind randomized placebo-controlled study of OIT for egg that assessed outcomes including both desensitization and sustained unresponsiveness.PubMedCentralPubMedCrossRef

14.

Buchanan AD, Green TD, Jones SM, Scurlock AM, Christie L, Althage KA, et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol. 2007;119(1):199–205. doi:10.1016/j.jaci.2006.09.016.PubMedCrossRef

15.•

Keet CA, Frischmeyer-Guerrerio PA, Thyagarajan A, Schroeder JT, Hamilton RG, Boden S, et al. The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol. 2012;129(2):448–55. doi:10.1016/j.jaci.2011.10.023. 55 e1–5. A direct comparison of SLIT and two doses of OIT for the treatment of milk allergy, showing a dose effect on the induction of desensitization and sustained unresponsiveness.PubMedCentralPubMedCrossRef

16.

Anagnostou K, Islam S, King Y, Foley L, Pasea L, Bond S, et al. Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a phase 2 randomised controlled trial. Lancet. 2014;383(9925):1297–304. doi:10.1016/S0140-6736(13)62301-6.PubMedCentralPubMedCrossRef

17.•

Caminiti L, Pajno GB, Crisafulli G, Chiera F, Collura M, Panasci G, et al. Oral immunotherapy for egg allergy: a double-blind placebo-controlled study, with postdesensitization follow-up. J Allergy Clin Immunol Pract. 2015. doi:10.1016/j.jaip.2015.01.017. A double-blind placebo-controlled study of egg OIT, followed by inclusion of egg into the diet and a sustained unresponsiveness challenge.PubMed

18.

Skripak JM, Nash SD, Rowley H, Brereton NH, Oh S, Hamilton RG, et al. A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow’s milk allergy. J Allergy Clin Immunol. 2008;122(6):1154–60. doi:10.1016/j.jaci.2008.09.030.

19.

Sampson HA. Peanut oral immunotherapy: is it ready for clinical practice? J Allergy Clin Immunol Pract. 2013;1(1):15–21. doi:10.1016/j.jaip.2012.10.009.PubMedCrossRef

20.

Vazquez-Ortiz M, Alvaro-Lozano M, Alsina L, Garcia-Paba MB, Piquer-Gibert M, Giner-Munoz MT, et al. Safety and predictors of adverse events during oral immunotherapy for milk allergy: severity of reaction at oral challenge, specific IgE and prick test. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2013;43(1):92–102. doi:10.1111/cea.12012.CrossRef

21.

Vazquez-Ortiz M, Alvaro M, Piquer M, Dominguez O, Machinena A, Martin-Mateos MA, et al. Baseline specific IgE levels are useful to predict safety of oral immunotherapy in egg-allergic children. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2014;44(1):130–41. doi:10.1111/cea.12233.CrossRef

22.

Morais Silva P, Antunes J, Chambel M, Prates S, Leiria PP. Diagnosis of eosinophilic esophagitis in an infant undergoing milk oral immunotherapy—a case report. Eur Ann Allergy Clin Immunol. 2014;46(4):154–6.PubMed

23.

Ridolo E, De Angelis GL, Dall’aglio P. Eosinophilic esophagitis after specific oral tolerance induction for egg protein. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2011;106(1):73–4. doi:10.1016/j.anai.2010.10.010.CrossRef

24.

Sanchez-Garcia S, Rodriguez Del Rio P, Escudero C, Martinez-Gomez MJ, Ibanez MD. Possible eosinophilic esophagitis induced by milk oral immunotherapy. J Allergy Clin Immunol. 2012;129(4):1155–7. doi:10.1016/j.jaci.2011.11.042.PubMedCrossRef

25.

Fuentes-Aparicio V, Alvarez-Perea A, Infante S, Zapatero L, D’Oleo A, Alonso-Lebrero E. Specific oral tolerance induction in paediatric patients with persistent egg allergy. Allergol Immunopathol. 2013;41(3):143–50. doi:10.1016/j.aller.2012.02.007.CrossRef

26.

Hofmann AM, Scurlock AM, Jones SM, Palmer KP, Lokhnygina Y, Steele PH, et al. Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol. 2009;124(2):286–91. doi:10.1016/j.jaci.2009.03.045. 91 e1–6.PubMedCentralPubMedCrossRef

27.

Lucendo AJ, Arias A, Tenias JM. Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with meta-analysis. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2014;113(6):624–9. doi:10.1016/j.anai.2014.08.004.CrossRef

28.•

Keet CA, Seopaul S, Knorr S, Narisety S, Skripak J, Wood RA. Long-term follow-up of oral immunotherapy for cow’s milk allergy. J Allergy Clin Immunol. 2013;132(3):737–9 e6. doi:10.1016/j.jaci.2013.05.006. This long-term follow-up of a milk OIT study provides data showing that successful completion of a sustained unresponsiveness challenge does not necessarily predict successful incorporation of milk into the diet, and highlights the need for long-term study of food immunotherapy outcomes.PubMedCentralPubMedCrossRef

29.

Allam JP, Stojanovski G, Friedrichs N, Peng W, Bieber T, Wenzel J, et al. Distribution of Langerhans cells and mast cells within the human oral mucosa: new application sites of allergens in sublingual immunotherapy? Allergy. 2008;63(6):720–7. doi:10.1111/j.1398-9995.2007.01611.x.PubMedCrossRef

30.

Kim EH, Bird JA, Kulis M, Laubach S, Pons L, Shreffler W, et al. Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol. 2011;127(3):640–6 e1. doi:10.1016/j.jaci.2010.12.1083.PubMedCentralPubMedCrossRef

31.

Fleischer DM, Burks AW, Vickery BP, Scurlock AM, Wood RA, Jones SM, et al. Sublingual immunotherapy for peanut allergy: a randomized, double-blind, placebo-controlled multicenter trial. J Allergy Clin Immunol. 2013;131(1):119–27 e1-7. doi:10.1016/j.jaci.2012.11.011.PubMedCentralPubMedCrossRef

32.

Chin SJ, Vickery BP, Kulis MD, Kim EH, Varshney P, Steele P, et al. Sublingual versus oral immunotherapy for peanut-allergic children: a retrospective comparison. J Allergy Clin Immunol. 2013;132(2):476–8 e2. doi:10.1016/j.jaci.2013.02.017.PubMedCentralPubMedCrossRef

33.

Burks AW, Wood RA, Jones SM, Sicherer SH, Fleischer DM, Scurlock AM, et al. Sublingual immunotherapy for peanut allergy: long-term follow-up of a randomized multicenter trial. J Allergy Clin Immunol. 2015. doi:10.1016/j.jaci.2014.12.1917.PubMedCentral

34.

Dioszeghy V, Mondoulet L, Dhelft V, Ligouis M, Puteaux E, Benhamou PH, et al. Epicutaneous immunotherapy results in rapid allergen uptake by dendritic cells through intact skin and downregulates the allergen-specific response in sensitized mice. J Immunol. 2011;186(10):5629–37. doi:10.4049/jimmunol.1003134.PubMedCrossRef

35.

Tordesillas L, Goswami R, Benede S, Grishina G, Dunkin D, Jarvinen KM, et al. Skin exposure promotes a Th2-dependent sensitization to peanut allergens. J Clin Invest. 2014;124(11):4965–75. doi:10.1172/JCI75660.PubMedCentralPubMedCrossRef

36.

Brough HA, Simpson A, Makinson K, Hankinson J, Brown S, Douiri A, et al. Peanut allergy: effect of environmental peanut exposure in children with filaggrin loss-of-function mutations. J Allergy Clin Immunol. 2014;134(4):867–75 e1. doi:10.1016/j.jaci.2014.08.011.PubMedCentralPubMedCrossRef

37.

Fox AT, Sasieni P, du Toit G, Syed H, Lack G. Household peanut consumption as a risk factor for the development of peanut allergy. J Allergy Clin Immunol. 2009;123(2):417–23. doi:10.1016/j.jaci.2008.12.014.PubMedCrossRef

38.•

Dioszeghy V, Mondoulet L, Dhelft V, Ligouis M, Puteaux E, Dupont C, et al. The regulatory T cells induction by epicutaneous immunotherapy is sustained and mediates long-term protection from eosinophilic disorders in peanut-sensitized mice. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2014;44(6):867–81. doi:10.1111/cea.12312. This pre-clinical study shows that application of allergen by the epicutaneous route can generate regulatory tolerance and suppress allergic inflammation in the gastrointestinal tract.CrossRef

39.

Dupont C, Kalach N, Soulaines P, Legoue-Morillon S, Piloquet H, Benhamou PH. Cow’s milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol. 2010;125(5):1165–7. doi:10.1016/j.jaci.2010.02.029.PubMedCrossRef

40.

Dupont C, Bourrier T, de Blay F, Guénard-Bilbault L, Sauvage C, Cousin M-O, et al. Peanut epicutaneous immunotherapy (EPIT) in peanut-allergic children: 18 months treatment in the Arachild Study. J Allergy Clin Immunol. 2014;133(2, Supplement):AB102. doi:10.1016/j.jaci.2013.12.381.CrossRef

41.

Sampson HA, Agbotounou W, Thébault C, Charles R, Martin L, Yang WH, et al. Epicutaneous immunotherapy (EPIT) is effective and safe to treat peanut allergy: a multi-national double-blind placebo-controlled randomized phase IIb trial. J Allergy Clin Immunol. 2015;135(2, Supplement):AB390. doi:10.1016/j.jaci.2014.12.1901.CrossRef

42.•

Syed A, Garcia MA, Lyu SC, Bucayu R, Kohli A, Ishida S, et al. Peanut oral immunotherapy results in increased antigen-induced regulatory T-cell function and hypomethylation of forkhead box protein 3 (FOXP3). J Allergy Clin Immunol. 2014;133(2):500–10. doi:10.1016/j.jaci.2013.12.1037. This mechanistic study identifies a key role of dendritic cells in determining the regulatory phenotype of T cells after OIT.PubMedCentralPubMedCrossRef

43.•

Gorelik M, Narisety SD, Guerrerio AL, Chichester KL, Keet CA, Bieneman AP, et al. Suppression of the immunologic response to peanut during immunotherapy is often transient. J Allergy Clin Immunol. 2014. doi:10.1016/j.jaci.2014.11.010. This mechanistic study shows that immune modifications induced by OIT and SLIT are not sustained, potentially explaining the need for maintained allergen exposure. Bystander effects of immunotherapy on basophil and T cell responses to dust mite are shown.

44.

Frischmeyer-Guerrerio PA, Keet CA, Guerrerio AL, Chichester KL, Bieneman AP, Hamilton RG, et al. Modulation of dendritic cell innate and adaptive immune functions by oral and sublingual immunotherapy. Clin Immunol. 2014;155(1):47–59. doi:10.1016/j.clim.2014.08.006.PubMedCrossRef

45.

Thyagarajan A, Jones SM, Calatroni A, Pons L, Kulis M, Woo CS, et al. Evidence of pathway-specific basophil anergy induced by peanut oral immunotherapy in peanut-allergic children. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2012;42(8):1197–205. doi:10.1111/j.1365-2222.2012.04028.x.CrossRef

46.

Burton OT, Logsdon SL, Zhou JS, Medina-Tamayo J, Abdel-Gadir A, Noval Rivas M, et al. Oral immunotherapy induces IgG antibodies that act through FcgammaRIIb to suppress IgE-mediated hypersensitivity. J Allergy Clin Immunol. 2014;134(6):1310–7 e6. doi:10.1016/j.jaci.2014.05.042.PubMedCrossRef

47.

Bedoret D, Singh AK, Shaw V, Hoyte EG, Hamilton R, DeKruyff RH, et al. Changes in antigen-specific T-cell number and function during oral desensitization in cow’s milk allergy enabled with omalizumab. Mucosal Immunol. 2012;5(3):267–76. doi:10.1038/mi.2012.5.PubMedCentralPubMedCrossRef

48.

Frischmeyer-Guerrerio PA, Guerrerio AL, Chichester KL, Bieneman AP, Hamilton RA, Wood RA, et al. Dendritic cell and T cell responses in children with food allergy. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2011;41(1):61–71. doi:10.1111/j.1365-2222.2010.03606.x.CrossRef

49.

Sallmann E, Reininger B, Brandt S, Duschek N, Hoflehner E, Garner-Spitzer E, et al. High-affinity IgE receptors on dendritic cells exacerbate Th2-dependent inflammation. J Immunol. 2011;187(1):164–71. doi:10.4049/jimmunol.1003392.PubMedCrossRef

50.

Zaleska A, Eiwegger T, Soyer O, van de Veen W, Rhyner C, Soyka MB, et al. Immune regulation by intralymphatic immunotherapy with modular allergen translocation MAT vaccine. Allergy. 2014;69(9):1162–70. doi:10.1111/all.12461.PubMedCrossRef

51.

Casale TB, Stokes JR. Immunotherapy: what lies beyond. J Allergy Clin Immunol. 2014;133(3):612–9. doi:10.1016/j.jaci.2014.01.007. quiz 20.PubMedCrossRef

Titel: An Examination of Clinical and Immunologic Outcomes in Food Allergen Immunotherapy by Route of Administration
verfasst von: David Chiang
M. Cecilia Berin
Publikationsdatum: 01.06.2015
Verlag: Springer US
Erschienen in: Current Allergy and Asthma Reports / Ausgabe 6/2015
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI: https://doi.org/10.1007/s11882-015-0536-y

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An Examination of Clinical and Immunologic Outcomes in Food Allergen Immunotherapy by Route of Administration

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