Skip to content

Advertisement

  • Meeting abstract
  • Open Access

Oral immunotherapy in clinical practice

  • Stefania Arasi1,
  • Lucia Caminiti1,
  • Giuseppe Crisafulli1 and
  • Giovanni B Pajno1Email author
Italian Journal of Pediatrics201541(Suppl 2):A2

https://doi.org/10.1186/1824-7288-41-S2-A2

Published: 30 September 2015

Keywords

Food AllergyOmalizumabContinuous AssumptionQualified PersonnelAccidental Ingestion

Introduction

Food avoidance is still considered the gold-standard treatment for food allergy (FA). However, recently it has been consolidating the theory that, where possible, the food intake might facilitate the induction of desensitization and tolerance, resulting more effective and safer -if we consider the possibility of accidental ingestion- than a strict avoidance diet [1].

Furthermore, specific oral immunotherapy (OIT) is the unique active treatment for IgE-mediated FAs [1].

Efficacy

Studies have shown short-term efficacy: namely theOIT-ability to induce desensitization (loss of responsiveness to food-antigen during continuous assumption of OIT-doses) [25]. Conversely, data are still insufficient and controversial regarding long-term efficacy: namely, the achievementof tolerance(configured when the offending food is removed from the diet and, if reintroduced, does not elicit any adversereaction) [25].

Recent data have shown that a key role in the induction of tolerance by OIT is played by a subgroup of regulatory T cells known as “induced T reg” (iTreg) [6, 7]. Epigenetic studies in vivo assessthatOIT determines hypomethylation of FOXP3 protein in specific antigen-iTreg only in individuals tolerant. Therefore, changes in the DNA of iTreg - specific antigen may predict the development of a state of clinical immune tolerance during OIT [8].

Safety

About safety, allergic reactions occurred in the majority of patients treated. They are primarily mild reactions, severe in about 4%; however, no threatening-life events nor death has been reported [9]. Frequency and severity of side effects seem reduced in protocols involving more gradual dose increases [1].

Careful clinical monitoring by qualified personnel in a medical environment is essential. Consequently, OIT costs are high.

In all immunotherapy treatments, safety is of paramount importance. Therefore, when severe adverse reactions occur, OIT should be stopped and revaluated.

Possible approches improving OIT

Several efforts have been made to perfect OIT: e.g.antigens with reduced allergenicity and adjuvants inducing faster immune responses of “protection”. Particularly promising is OIT associated with omalizumab, anti-IgE antibody, resulting safe and able to accelerate the desensitization compared to traditional protocols [1012].

Conclusions

Further researches are needed in order to verify the degree of long-term safety as well as the long-term efficacy of OIT.

Given the interest and the celerity of development of this field of research in the recent years, we are confident in the near achievement of a personalized treatment, planned, safe and effective, to be used in clinical practice.

Authors’ Affiliations

(1)
Department of Pediatrics-Allergy Unit, University of Messina, Messina, Italy

References

  1. Pajno GB, Nadeau KC, Passalacqua G, Caminiti L, Hobson B, Jay DC, et al: The evolution of allergen and non-specific immunotherapy: past achievements, current applications and future outlook. Expert Rev Clin Immunol. 2015, 11: 141-54. 10.1586/1744666X.2015.977260.PubMedView ArticleGoogle Scholar
  2. Shekelle P, Maglione M, Riedl M, et al: Food Allergy: Evidence Report. Accessed at http://www.rand.org/health/centers/epc/
  3. Chafen JJ, Newberry SJ, Riedl MA, Bravata DM, Maglione M, Suttorp MJ, et al: Diagnosing and Managing Common Food Allergies: A Systematic Review. JAMA. 2010, 303: 1848-1856. 10.1001/jama.2010.582.PubMedView ArticleGoogle Scholar
  4. Calvani M, Giorgio V, Miceli Sopo S: Specific oral tolerance induction for food. A systematic review. Eur Ann Allergy Clin Immunol. 2010, 42: 11-19.PubMedGoogle Scholar
  5. Fisher HR, du Toit G, Lack G: Specific oral tolerance induction in food allergic children: is oral desensitisation more effective than allergen avoidance? A meta-analysis of published RCTs. Arch Dis Child. 2011, 96: 259-264. 10.1136/adc.2009.172460.PubMedView ArticleGoogle Scholar
  6. Soyer O U, Akdis M, Ring J, Behrendt H, Crameri R, Lauener R, et al: Mechanisms of peripheral tolerance to allergens. Allergy. 2013, 68: 161-170. 10.1111/all.12085.PubMedView ArticleGoogle Scholar
  7. Pajno GB, Cox L, Caminiti L, Ramistella V, Crisafulli G: Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated Food Allergy: The Transition to Clinical Practice. Pediatr Allergy Immunol Pulmonol. 2014, 27: 42-50. 10.1089/ped.2014.0332.PubMedPubMed CentralView ArticleGoogle Scholar
  8. 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 Immunology. 2014, 10: 1-Google Scholar
  9. Kim EH, Burks W: Managing food allergy in childhood. Curr Opin Pediatr. 2012, 24: 615-20. 10.1097/MOP.0b013e32835741e3.PubMedView ArticleGoogle Scholar
  10. Nadeau KC, Schneider LC, Hoyte L, Borras I, Umetsu DT: Rapid oral desensitization in combination with omalizumab therapy in patients with cow's milk allergy. J Allergy Clin Immunol. 2011, 127: 1622-4. 10.1016/j.jaci.2011.04.009.PubMedPubMed CentralView ArticleGoogle Scholar
  11. Schneider LC, Rachid R, Lebovidge J, Blood E, Mittal M, Umetsu DT: A pilot study of omalizumab to facilitate rapid oral desensitization in high-risk peanut-allergic patients. J Allergy Clin Immunol. 2013, 132: 1368-1374. 10.1016/j.jaci.2013.09.046.PubMedPubMed CentralView ArticleGoogle Scholar
  12. Bégin P, Dominguez T, Wilson SP, Bacal L, Mehrotra A, Kausch B, 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: 7-10.1186/1710-1492-10-7.PubMedPubMed CentralView ArticleGoogle Scholar

Copyright

© Arasi et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement