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Current Allergy and Asthma Reports
Erschienen in: Current Allergy and Asthma Reports 4/2016

01.03.2016 | Immunotherapy and Immunomodulators (B Vickery, Section Editor)

The Heterogeneity of Oral Immunotherapy Clinical Trials: Implications and Future Directions

verfasst von: Christina S. K. Yee, Rima Rachid

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 4/2016

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Abstract

Food allergy is a potentially life-threatening disease which affects up to 8 % of children and 2–3 % of adults. Increasing food allergy prevalence poses a major public health concern. Induction of desensitization to food allergens through oral immunotherapy (OIT) is an expanding area of study encompassing peanut, egg, milk, and other food allergens. OIT consists of administering incremental doses of food allergen to food-allergic patients, to induce a state of desensitization. Safety, tolerability, and efficacy all remain ongoing concerns. Clinical trials for oral immunotherapy have encompassed many variations, including differences in dosage sizes and frequency, duration of build-up, type of allergen used, patient characteristics, and adjuvant therapies. Consequently, studies have also shown variation in rates of adverse effects, and successful desensitization. Here, we provide an overview of the key studies and discuss the implications of this heterogeneity. While desensitization is successful in the majority of patients, only a minority appear to develop sustained unresponsiveness even after years of therapy. Much larger and longitudinal studies using more homogenous protocols are needed in order to evaluate the clinical applicability of OIT, its long-term effectiveness, and effect on quality of life. The role of adjunctive therapies, including omalizumab and probiotics, requires further evaluation.
Literatur
1.
Gupta RS et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1):e9–17.CrossRefPubMed
2.
Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124(6):1549–55.CrossRefPubMed
3.
Sicherer SH, Sampson HA. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014;133(2):291–307. quiz 308.CrossRefPubMed
4.
Liu AH et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005–2006. J Allergy Clin Immunol. 2010;126(4):798–806. e13.CrossRefPubMedPubMedCentral
5.
Rona RJ et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007;120(3):638–46.CrossRefPubMed
6.
Host A. Clinical course of cow’s milk protein allergy and intolerance. Pediatr Allergy Immunol. 1998;9(11 Suppl):48–52.PubMed
7.
Host A et al. Clinical course of cow’s milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol. 2002;13 Suppl 15:23–8.CrossRefPubMed
8.
Savage JH et al. The natural history of egg allergy. J Allergy Clin Immunol. 2007;120(6):1413–7.CrossRefPubMed
9.
10.
Skolnick HS et al. The natural history of peanut allergy. J Allergy Clin Immunol. 2001;107(2):367–74.CrossRefPubMed
11.
Fleischer DM et al. The natural history of tree nut allergy. J Allergy Clin Immunol. 2005;116(5):1087–93.CrossRefPubMed
12.
Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001;107(1):191–3.CrossRefPubMed
13.
Bock SA, Munoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001–2006. J Allergy Clin Immunol. 2007;119(4):1016–8.CrossRefPubMed
14.
Muraro A et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014;69(8):1008–25.CrossRefPubMed
15.
Panel NI-SE et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1–58.
16.
Muraro A et al. EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community. Allergy. 2014;69(8):1046–57.CrossRefPubMed
17.
Sampson HA et al. Food allergy: a practice parameter update—2014. J Allergy Clin Immunol. 2014;134(5):1016–25. e43.CrossRefPubMed
18.
Cummings AJ et al. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy. 2010;65(8):933–45.CrossRefPubMed
19.
Lieberman JA, Sicherer SH. Quality of life in food allergy. Curr Opin Allergy Clin Immunol. 2011;11(3):236–42.CrossRefPubMed
20.
van der Velde JL, Dubois AE, Flokstra-de Blok BM. Food allergy and quality of life: what have we learned? Curr Allergy Asthma Rep. 2013;13(6):651–61.CrossRefPubMed
21.
Anagnostou K et al. Efficacy and safety of high-dose peanut oral immunotherapy with factors predicting outcome. Clin Exp Allergy. 2011;41(9):1273–81.CrossRefPubMed
22.
Blumchen K et al. Oral peanut immunotherapy in children with peanut anaphylaxis. J Allergy Clin Immunol. 2010;126(1):83–91. e1.CrossRefPubMed
23.
Clark AT et al. Successful oral tolerance induction in severe peanut allergy. Allergy. 2009;64(8):1218–20.CrossRefPubMed
24.
Jones SM et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol. 2009;124(2):292–300. 300 e1–97.CrossRefPubMedPubMedCentral
25.
Narisety SD 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. 2015;135(5):1275–82. e1–6.CrossRefPubMed
26.
Patriarca G et al. Oral rush desensitization in peanut allergy: a case report. Dig Dis Sci. 2006;51(3):471–3.CrossRefPubMed
27.•
Varshney 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. First double-blind, placebo-controlled RCT of peanut OIT. CrossRefPubMedPubMedCentral
28.
Keet CA et al. The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol. 2012;129(2):448–55. 455 e1–5. CrossRefPubMedPubMedCentral
29.
Longo G et al. Specific oral tolerance induction in children with very severe cow’s milk-induced reactions. J Allergy Clin Immunol. 2008;121(2):343–7.CrossRefPubMed
30.
Meglio P et al. A protocol for oral desensitization in children with IgE-mediated cow’s milk allergy. Allergy. 2004;59(9):980–7.CrossRefPubMed
31.
Skripak JM 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.CrossRefPubMedPubMedCentral
32.
Buchanan AD et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol. 2007;119(1):199–205.CrossRefPubMed
33.
Caminiti L et al. Oral immunotherapy for egg allergy: a double-blind placebo-controlled study, with postdesensitization follow-up. J Allergy Clin Immunol. 2015;3(4):532–9.CrossRef
34.
Dello Iacono I et al. Specific oral tolerance induction with raw hen’s egg in children with very severe egg allergy: a randomized controlled trial. Pediatr Allergy Immunol. 2013;24(1):66–74.CrossRefPubMed
35.
Fuentes-Aparicio V et al. Specific oral tolerance induction in paediatric patients with persistent egg allergy. Allergol Immunopathol. 2013;41(3):143–50.CrossRef
36.
Garcia Rodriguez R et al. Oral rush desensitization to egg: efficacy and safety. Clin Exp Allergy. 2011;41(9):1289–96.CrossRefPubMed
37.
Itoh N, Itagaki Y, Kurihara K. Rush specific oral tolerance induction in school-age children with severe egg allergy: one year follow up. Allergol Int. 2010;59(1):43–51.CrossRefPubMed
38.
Letran A et al. Threshold doses in specific oral tolerance induction in children with egg allergy. J Investig Allergol Clin Immunol. 2012;22(2):147–9.PubMed
39.
Meglio P et al. Oral food desensitization in children with IgE-mediated hen’s egg allergy: a new protocol with raw hen’s egg. Pediatr Allergy Immunol. 2013;24(1):75–83.CrossRefPubMed
40.
Morisset M et al. Oral desensitization in children with milk and egg allergies obtains recovery in a significant proportion of cases. A randomized study in 60 children with cow’s milk allergy and 90 children with egg allergy. Eur Ann Allergy Clin Immunol. 2007;39(1):12–9.PubMed
41.
Ojeda P et al. Home-based oral immunotherapy protocol with pasteurized egg for children allergic to hen’s egg. Isr Med Assoc J. 2012;14(1):34–9.PubMed
42.
Patriarca G et al. Oral specific desensitization in food-allergic children. Dig Dis Sci. 2007;52(7):1662–72.CrossRefPubMed
43.
Ruiz Garcia M et al. Commercial dehydrated egg white for specific oral tolerance induction (SOTI): an easier treatment for egg allergy. J Investig Allergol Clin Immunol. 2012;22(7):529–31.PubMed
44.
Staden U et al. Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy. 2007;62(11):1261–9.CrossRefPubMed
45.
Tortajada-Girbes M et al. Specific oral tolerance induction (SOTI) to egg: our experience with 19 children. J Investig Allergol Clin Immunol. 2012;22(1):75–7.PubMed
46.
Vazquez-Ortiz M et al. Baseline specific IgE levels are useful to predict safety of oral immunotherapy in egg-allergic children. Clin Exp Allergy. 2014;44(1):130–41.CrossRefPubMed
47.
Vickery BP et al. Individualized IgE-based dosing of egg oral immunotherapy and the development of tolerance. Ann Allergy Asthma Immunol. 2010;105(6):444–50.CrossRefPubMedPubMedCentral
48.
Pacharn P et al. Successful wheat-specific oral immunotherapy in highly sensitive individuals with a novel multirush/maintenance regimen. Asia Pac Allergy. 2014;4(3):180–3.CrossRefPubMedPubMedCentral
49.
Rodriguez del Rio P et al. Oral immunotherapy in children with IgE-mediated wheat allergy: outcome and molecular changes. J Investig Allergol Clin Immunol. 2014;24(4):240–8.PubMed
50.
Sato S et al. Wheat oral immunotherapy for wheat-induced anaphylaxis. J Allergy Clin Immunol. 2015;136(4):1131–3. e7.CrossRefPubMed
51.
Begin P, Chinthrajah RS, Nadeau KC. Oral immunotherapy for the treatment of food allergy. Hum Vaccin Immunother. 2014;10(8):2295–302.CrossRefPubMed
52.
53.
Hofmann AM et al. Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol. 2009;124(2):286–91. 291 e1–6. CrossRefPubMedPubMedCentral
54.••
Vickery BP et al. Sustained unresponsiveness to peanut in subjects who have completed peanut oral immunotherapy. J Allergy Clin Immunol. 2014;133(2):468–75. Long-term study of sustained unresponsiveness in peanut OIT trial. CrossRefPubMedPubMedCentral
55.••
Anagnostou K 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. Large-scale RCT for peanut OIT. CrossRefPubMedPubMedCentral
56.
Syed A 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.CrossRefPubMedPubMedCentral
57.
Bird JA, Spergel J, Jones SM, Rachid R, Assa’ad AH, Wang J, Leonard SA, Laubach SS, Kim EH, Vickery BP, Davis B, Heimall J, Cinaferoni A, MacGinnitie AJ, Crestani E, Elfont RM, Sampson HA, Burks AW. A novel characterized peanut allergen formulation (AR101) for oral immunotherapy (OIT) induces desensitization in peanut-allergic subjects: a phase 2 clinical safety and efficacy study, in EAACI 2015. Barcelona, Spain; 2015.
58.
Schneider LC et al. A pilot study of omalizumab to facilitate rapid oral desensitization in high-risk peanut-allergic patients. J Allergy Clin Immunol. 2013;132(6):1368–74.CrossRefPubMedPubMedCentral
59.
Burton OT 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.CrossRefPubMedPubMedCentral
60.
Tang ML et al. Administration of a probiotic with peanut oral immunotherapy: a randomized trial. J Allergy Clin Immunol. 2015;135(3):737–44. e8.CrossRefPubMed
61.
Meglio P et al. Oral desensitization in children with immunoglobulin E-mediated cow’s milk allergy—follow-up at 4 yr and 8 months. Pediatr Allergy Immunol. 2008;19(5):412–9.CrossRefPubMed
62.
Narisety SD et al. Open-label maintenance after milk oral immunotherapy for IgE-mediated cow’s milk allergy. J Allergy Clin Immunol. 2009;124(3):610–2.CrossRefPubMedPubMedCentral
63.••
Keet CA et al. Long-term follow-up of oral immunotherapy for cow’s milk allergy. J Allergy Clin Immunol. 2013;132(3):737–739 e6. Long term evaluation of outcomes for milk OIT. CrossRefPubMedPubMedCentral
64.
Caminiti L et al. A new protocol for specific oral tolerance induction in children with IgE-mediated cow’s milk allergy. Allergy Asthma Proc. 2009;30(4):443–8.CrossRefPubMed
65.
Pajno GB et al. Oral immunotherapy for cow’s milk allergy with a weekly up-dosing regimen: a randomized single-blind controlled study. Ann Allergy Asthma Immunol. 2010;105(5):376–81.CrossRefPubMed
66.
Pajno GB et al. Comparison between two maintenance feeding regimens after successful cow’s milk oral desensitization. Pediatr Allergy Immunol. 2013;24(4):376–81.CrossRefPubMed
67.
Martorell A et al. Oral desensitization as a useful treatment in 2-year-old children with cow’s milk allergy. Clin Exp Allergy. 2011;41(9):1297–304.CrossRefPubMed
68.
Salmivesi S et al. Milk oral immunotherapy is effective in school-aged children. Acta Paediatr. 2013;102(2):172–6.CrossRefPubMed
69.•
Paassilta M et al. Children who were treated with oral immunotherapy for cows’ milk allergy showed long-term desensitisation seven years later. Acta Paediatr. 2016;105(2):215–9. Placebo-controlled RCT of milk OIT with long-term follow-up. CrossRefPubMed
70.
Nadeau KC et al. Rapid oral desensitization in combination with omalizumab therapy in patients with cow’s milk allergy. J Allergy Clin Immunol. 2011;127(6):1622–4.CrossRefPubMedPubMedCentral
71.••
Wood RA, et al. A randomized, double-blind, placebo-controlled study of omalizumab combined with oral immunotherapy for the treatment of cow’s milk allergy. J Allergy Clin Immunol. 2015. Double-blinded, placebo-controlled RCT of omalizumab as adjunct to milk OIT.
72.
Goldberg MR et al. Efficacy of baked milk oral immunotherapy in baked milk-reactive allergic patients. J Allergy Clin Immunol. 2015;136(6):1601–6.CrossRefPubMed
73.
Burks AW, Jones SM. Egg oral immunotherapy in non-anaphylactic children with egg allergy: follow-up. J Allergy Clin Immunol. 2008;121(1):270–1.CrossRefPubMed
74.••
Burks AW et al. Oral immunotherapy for treatment of egg allergy in children. N Engl J Med. 2012;367(3):233–43. Large-scale, double-blind, placebo-controlled RCT for egg OIT. CrossRefPubMedPubMedCentral
75.
Escudero C et al. Early sustained unresponsiveness after short-course egg oral immunotherapy: a randomized controlled study in egg-allergic children. Clin Exp Allergy. 2015;45(12):1833–43.CrossRefPubMed
76.
77.
Begin P et al. Phase 1 results of safety and tolerability in a rush oral immunotherapy protocol to multiple foods using Omalizumab. Allergy Asthma Clin Immunol. 2014;10(1):7.CrossRefPubMedPubMedCentral
78.
Henson, M., et al., Peanut oral immunotherapy and omalizmab treatment for peanut allergy. J Allergy Clin Immunol. 2012; 6749:S0091(11):11.
79.
Takahashi M et al. New efficacy of LTRAs (montelukast sodium): it possibly prevents food-induced abdominal symptoms during oral immunotherapy. Allergy Asthma Clin Immunol. 2014;10(1):3.CrossRefPubMedPubMedCentral
80.
Mansfield L. Successful oral desensitization for systemic peanut allergy. Ann Allergy Asthma Immunol. 2006;97(2):266–7.CrossRefPubMed
81.
Bird JA, Spergel J, Jones SM, Rachid R, Assa’ad AH, Wang J, Leonard SA, Laubach SS, Kim EH, Vickery BP, Davis B, Heimall J, Cinaferoni A, MacGinnitie AJ, Crestani E, Elfont RM, Sampson HA, Burks AW. A novel characterized peanut allergen formulation (AR101) for oral immunotherapy (OIT) induces desensitization in peanut-allergic subjects: a phase 2 clinical safety and efficacy study, in EAACI. Barcelona, Spain; 2015.
82.
Leung DY et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med. 2003;348(11):986–93.CrossRefPubMed
83.
84.
Patriarca C et al. Oral specific hyposensitization in the management of patients allergic to food. Allergol Immunopathol. 1984;12(4):275–81.
85.
Yeung JP et al. Oral immunotherapy for milk allergy. Cochrane Database Syst Rev. 2012;11, CD009542.PubMed
86.•
Ibanez MD et al. Comprehensive review of current knowledge on egg oral immunotherapy. J Investig Allergol Clin Immunol. 2015;25(5):316–28. Quiz 2 p following 328; Comprehensive review of egg OIT clinical studies. PubMed
87.•
Romantsik O et al. Oral and sublingual immunotherapy for egg allergy. Cochrane Database Syst Rev. 2014;11, CD010638. Meta-analysis of recent egg OIT RCT. PubMed
88.•
Rachid R, Umetsu DT. Immunological mechanisms for desensitization and tolerance in food allergy. Semin Immunopathol. 2012;34(5):689–702. Review of mechanisms of tolerance in OIT. CrossRefPubMedPubMedCentral
89.
Arasi S et al. Two year effects of food allergen immunotherapy on quality of life in caregivers of children with food allergies. Allergy Asthma Clin Immunol. 2014;10(1):57.CrossRefPubMedPubMedCentral
90.
Lebovidge JS et al. Assessment of psychological distress among children and adolescents with food allergy. J Allergy Clin Immunol. 2009;124(6):1282–8.CrossRefPubMed
91.
Otani IM et al. Multiple-allergen oral immunotherapy improves quality of life in caregivers of food-allergic pediatric subjects. Allergy Asthma Clin Immunol. 2014;10(1):25.CrossRefPubMedPubMedCentral
Metadaten
Titel
The Heterogeneity of Oral Immunotherapy Clinical Trials: Implications and Future Directions
verfasst von
Christina S. K. Yee
Rima Rachid
Publikationsdatum
01.03.2016
Verlag
Springer US
Erschienen in
Current Allergy and Asthma Reports / Ausgabe 4/2016
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-016-0602-0

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