Pioneering immunotherapy for food allergy: clinical outcomes and modulation of the immune response

There is no approved therapy for food allergies, which affect 12 million people in the United States and millions more worldwide. In the last few years, our research team at Duke has begun to develop protocols to treat peanut and other food allergies. Two distinct therapies are being developed. Oral immunotherapy (OIT), which relies on ingestion of increasing amounts of the allergenic food, has been used to successfully desensitize more than 50 peanut allergic subjects. Sublingual immunotherapy (SLIT) involves placing small quantities of peanut allergens under the tongue and has shown promise in our initial placebo-controlled clinical trial. Immunologic changes associated with OIT and SLIT include reduction in mast cell reactivity as determined by skin prick test size, decreased basophil responses, decreased specific-IgE, increased IgG4, and induction of regulatory T cells. Development of these immunotherapy strategies has generated much excitement in the food allergy community; however, further studies are needed before these approaches are ready for clinical use.