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Oral immunotherapy has attracted much interest as a potential treatment for food allergy, yet little is known about its long-term effects. We aimed to assess long-term outcomes in participants who completed a randomised, double-blind, placebo-controlled trial of combined probiotic and peanut oral immunotherapy (PPOIT), which was previously shown to induce desensitisation and 2-week sustained unresponsiveness.

Mikroflora jelit może odgrywać rolę w naturalnym przebiegu alergii na białka mleka krowiego.

This study reviews the newest developments on experimental therapies for the treatment of food allergy.

Food allergy is a difficult clinical problem for which no disease-modifying therapy currently exists.

Background: Food allergy is a major cause of life-threatening hypersensitivity reactions. Food-induced anaphylaxis is the most common reason for someone to present to the emergency department for an anaphylactic reaction. At present, the avoidance of the allergenic food is the only method of preventing further reactions for allergic patients. Objective: With better characterization of allergens and an understanding of the immunologic mechanism involved in this reaction, investigators have developed several therapeutic modalities potentially applicable to the treatment and eventual prevention of food allergy. This review identifies and discusses the potential treatment options for food allergy that are under development. Methods: Relevant articles are reviewed pertaining to the treatment of food allergy. Results/conclusion: Among the therapeutic options currently under investigation are anti-IgE therapy, peptide immunotherapy, traditional Chinese medicine, mutated protein immunotherapy, DNA immunization and immunization with immunostimulatory sequences linked to allergens. These novel forms of treatment for allergic disease hold promise for the safe and effective treatment of food-allergic individuals and the prevention of food allergy in the future.

Peanut allergy is among the most serious, life-threatening food sensitivities, and recent studies indicate increasing prevalence, particularly among children. Our objective is to highlight recent advances in the immunology and treatment of peanut allergy.

Food allergy is a major cause of life-threatening hypersensitivity reactions. Peanut allergy is the most serious of the hypersensitivity reactions to foods due to its persistence and high risk of severe anaphylaxis. Currently, strict avoidance of the allergenic food and ready access to self-injectable epinephrine is the ‘standard of care’ for food allergy. Based on extensive characterization of food allergens and a better understanding of the immunological mechanisms underlying allergic disease, promising therapeutic modalities for food allergy treatment and prevention are being developed.

Food allergy is a major cause of life-threatening hypersensitivity reactions. Currently, the strict avoidance of the allergenic food and ready access to self-injectable adrenaline is the standard of care for food allergy. Based on extensive characterisation of food allergens and a better understanding of the immunological mechanisms underlying allergic disease, promising therapeutic modalities for the treatment and eventual prevention of food allergy are being developed. Novel immunotherapeutic strategies include peptide immunotherapy, traditional Chinese medicine, mutated or homologous protein immunotherapy, DNA immunisation and immunisation with immunostimulatory sequences, which all strive to elicit a decreased T helper cell type 2-like response or tolerance by the immune system in response to a specific food allergen. Other approaches such as the anti-IgE therapy or the Fcγ–Fcε fusion protein aim at preventing the release of mediators by mast cells. It is the combination of these different approaches that would probably offer the best treatment option for food-allergic patients in a not too distant future.

Background: Peanut allergy (PNA) is a life-threatening food allergy for which there is no definitive treatment. Objective: We investigated the long-term immunomodulatory effect of heat-killed Escherichia coliproducing engineered (mutated) Ara h1, 2, and 3 (HKE-MP123) administered rectally (pr) in a murine model of PNA. Methods: Peanut-allergic C3H/HeJ mice received 0.9 (low dose), 9 (medium dose), or 90 (high dose) μg HKE-MP123 pr, HKE-containing vector (HKE-V) alone, or vehicle alone (sham) weekly for 3 weeks. Mice were challenged 2 weeks later. A second and third challenge were performed at 4-week intervals. Results: After the first challenge, all 3 HKE-MP123 and HKE-V-treated groups exhibited reduced symptom scores (P< .01, .01, .05, .05, respectively) compared with the sham-treated group. Interestingly, only the medium- and high-dose HKE-MP123-treated mice remained protected for up to 10 weeks after treatment accompanied by a significant reduction of plasma histamine levels compared with sham-treated mice (P< .05 and .01, respectively). IgE levels were significantly lower in all HKE-MP123-treated groups (P< .001), being most reduced in the high-dose HKE-MP123-treated group at the time of each challenge. IL-4, IL-13, IL-5, and IL-10 production by splenocytes of high-dose HKE-MP123-treated mice were significantly decreased (P< .01; .001, .001, and .001, respectively), and IFN-γ and TGF-β production were significantly increased (P< .001 and .01, respectively) compared with sham-treated mice at the time of the last challenge. Conclusions: Treatment with pr HKE-MP123 can induce long-term “downregulation” of peanut hypersensitivity, which might be secondary to decreased antigen-specific TH2 and increased TH1 and T regulatory cytokine production. (J Allergy Clin Immunol 2003;112:159-67.)

IgE-mediated hypersensitivity reactions account for the majority of well-documented food allergy reactions, but non-IgE-mediated immune mechanisms do cause some hypersensitivity disorders. A variety of gastrointestinal, cutaneous, respiratory, and generalized symptoms and syndromes have been associated with IgE-mediated food allergy. The diagnostic approach to adverse food reactions begins with a careful medical history and physical examination. Laboratory studies may then be used appropriately in the evaluation. Once the diagnosis of food allergy is established, the only proven therapy is the strict elimination of the food from the patient's diet. Studies in both children and adults indicate that symptomatic reactivity to food allergens is often lost over time, except possibly reactions to peanuts, tree nuts, and seafood.

A number of advances in the scientific knowledge concerning adverse food reactions have been made in the past few years. Understanding about the nature of the food allergen itself, the molecular characterization of the epitopes on these allergens, the pathophysiology of the clinical reaction, and the diagnostic methods have all been significantly enhanced.

Background:It has traditionally been assumed that peanut allergy is rarely outgrown. Objective:The goal of this study was to determine the number of children with peanut allergy who become tolerant of peanut. Methods:Patients aged 4 to 20 years with a diagnosis of peanut allergy were evaluated by questionnaire, skin testing, and a quantitative antibody fluorescent-enzyme immunoassay. Patients who had been reaction free in the past year and had a peanut IgE (PN-IgE) level less than 20 kilounits of antibody per liter (kUA/L) were offered an open or double-blind, placebo-controlled peanut challenge. Results:A total of 223 patients were evaluated, and of those, 85 (PN-IgE < 0.35-20.4 kUA/L [median 1.42 kUA/L]) participated in an oral peanut challenge. Forty-eight (21.5%) patients had negative challenge results and were believed to have outgrown their peanut allergy (aged 4-17.5 years [median 6 years]; PN-IgE < 0.35-20.4 kUA/L [median 0.69 kUA/L]). Thirty-seven failed the challenge (aged 4-13 years [median 6.5 years]; RAST < 0.35-18.2 kUA/L [median 2.06 kUA/L]). Forty-one patients with PN-IgE levels less than 20 kUA/L declined to undergo challenge, and 97 were not eligible for challenge because their PN-IgE levels were greater than 20 kUA/L or they had had a recent reaction. Sixty-seven percent of patients with PN-IgE levels less than 2 kUA/L and 61% with levels less than 5 kUA/L had negative challenge results. Of those who underwent challenge, PN-IgE levels for those who passed versus those who failed were different at the time of challenge (P= .009), but not at the time of diagnosis (P= .25). Conclusion:This study demonstrates that peanut allergy is outgrown in about 21.5% of patients. Patients with low PN-IgE levels should be offered a peanut challenge in a medical setting to demonstrate whether they can now tolerate peanuts. (J Allergy Clin Immunol 2001;107:367-74.)

Background:Few studies have evaluated IgE-mediated hypersensitivity to melon with details of clinical reactions confirmed by double-blind, placebo-controlled, food challenges (DBPCFCs). Objective:We sought to investigate clinical features (type and severity of reactions, age at onset, results of skin prick and in vitro tests, and incidence of other allergic diseases and associated food allergies) of acute allergic reactions to melon confirmed by DBPCFCs. Methods:Fifty-three consecutive adult patients complaining of adverse reactions to melon were included in the study. Skin prick tests and detection of specific IgE were performed in all patients with melon, avocado, kiwi, banana, chestnut, latex, pollen, and other offending foods. Patients first underwent an open food challenge, unless they had a convincing history of severe anaphylaxis. Positive open food challenge reactions were subsequently evaluated by DBPCFCs. Results:Actual clinical reactivity was confirmed in 19 (36%) of 53 patients. The most frequent symptom was oral allergy syndrome (n = 14), but two patients experienced life-threatening reactions, including respiratory symptoms and hypotension. The positive predictive value for a skin prick test was 42%, and that for specific IgE measurement was 44%. Forty-five reactions to 15 other foods were confirmed in 18 patients. The most common foods associated with melon allergy were avocado (n = 7), banana (n = 7), kiwi (n = 6), watermelon (n = 6), and peach (n = 5). Onset of melon-induced allergic symptoms occurred from 6 to 45 years (median, 20 years), preceded by seasonal rhinitis, asthma, or both in 88% (15/17). Conclusion:About one third of reported reactions to melon are confirmed by means of DBPCFC, which has been proven to be the most reliable procedure in the diagnosis of clinical fruit allergy. Isolated melon allergy is rare, with most patients either having allergic rhinitis, asthma, or both and associated food allergies. (J Allergy Clin Immunol 2000;106:968-72.)

The safety and clinical efficacy of a liquid, β-propiolactone-stabilized intravenous γ-globulin, Intraglobin-F, was evaluated in a multicenter, double-blind study comparing Intraglobin-F to Gamimune-N, Sandoglobulin, or Gammagard. β-Propiolactone stabilizes the IgG molecule to decrease aggregate formation and is a potent virucidal agent that reduces the risk of viral transmission by intravenous γ-globulin (IVIG) preparations. Twenty-seven patients with primary immunodeficiency diseases were enrolled at three centers. Each patient received 6 months of therapy with either Intraglobin-F or the IVIG preparation that they had received during the preceding 3 months, then crossed over to the other preparation. Twenty-three patients completed the study. One patient withdrew because of an adverse event, generalized urticaria. A second patient withdrew because of fatigue and perceived decreased efficacy. Adverse reactions were comparable and occurred in 8.7% of the infusions of Intraglobin-F and 6% of the infusions with Sandoglobulin. None were severe or life-threatening. There was no discernible difference in efficacy between any of the products. The number of days when patients noted symptoms in their diaries was similar for Intraglobin-F and the comparison preparations, 4158 vs 4143. Similarly, there were no differences in the number of physician visits (33 vs 22), days missed from work or school (405 vs 404), days with fever (41 vs 47), or days of prophylactic antibiotics (675 vs 642). There was an increase in the number of days when antibiotics were given therapeutically (578 vs 451); most of the difference was attributable to one patient. There also was a difference in the number of days of hospitalization (21 vs 0), but 19 of the days were accounted for by two patients. When the patients were asked to score their feeling of well-being on a scale of 1 to 5, with 1 being entirely well, the mean score for the patients on Intraglobin-F was 1.86 (range, 1.0 to 3.0), compared to 1.85 (range, 1.0 to 3.2) for patients while on the comparison preparations. Trough IgG levels were slightly lower during the period when patients were treated with Intraglobin-F compared to the other products. There were no abnormalities in blood chemistries or hematologic parameters. Thus, Intraglobin-F is comparable to three of the marketed IVIG preparations in efficacy and safety, as well as patient acceptability, and offers the additional benefit of an extra virucidal step to reduce further the risk of transmitting viral infections.

The incidence of all allergic diseases appears to be on the increase in industrialized societies. The standard methods of diagnosis food challenge and therapy avoidance for food allergies remain rather primitive, while the incidence of atopy appears to be increasing. However, a number of advances in recent years hold promise for improvement. This review summarizes important studies and concepts in the field of food allergies. Special emphasis is given to the areas of diagnosis and therapy.

We have previously developed a food allergy–specific developmental model, that explained emotions and coping styles, among children aged 6 to 15years in Ireland.

• Hemophiliacs infected with human immunodeficiency virus with a history of hypersensitivity reaction to a combination product of trimethoprim and sulfamethoxazole were desensitized orally. Six of the seven patients included in the study successfully completed the desensitization protocol and received trimethoprim-sulfamethoxazole for 5 to 7 months after desensitization (mean length of treatment, 5.7 months) for prophylaxis of Pneumocystis carinii pneumonia. The small number of patients and the short follow-up allow us to suggest that oral desensitization may be an effective and inexpensive means to treat hemophiliacs infected with human immunodeficiency virus with trimethoprim-sulfamethoxazole as prophylaxis against Pneumocystis carinii pneumonia.(AJDC. 1991;145:1428-1429)

The article reports on the multicenter trial conducted by the author and David M. Fleischer of National Jewish Health in Denver, Colorado, which suggests a treatment for peanut allergy. The author states that the trial shows promise for sublingual immunotherapy (SLIT) wherein patients are given increasing amounts of a liquid that contain peanut protein daily. He recommends that parents of children with peanut allergies should continue to make it sure that snacks do not contain peanuts.