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immunotherapies for food allergy

Rima Rachid, Talal A Chatila
PURPOSE OF REVIEW: The rise in the prevalence of food allergy over the past decades has focused attention of factors that may impact disease development, most notably the gut microbiota. The gut microbial communities play a crucial role in promoting oral tolerance. Their alteration by such factors as Cesarean section delivery, diet and antibiotics may influence disease development. This review highlights recent progress in our understanding of the role of the gut microbiota in the development of food allergy...
September 28, 2016: Current Opinion in Pediatrics
Thomas Holzhauser, Annegret Franke, Regina Treudler, Anett Schmiedeknecht, Stefanie Randow, Wolf-Meinhard Becker, Jonas Lidholm, Stefan Vieths, Jan-Christoph Simon
SCOPE: The BASALIT clinical trial (EudraCT 2009-011737-27) investigated efficacy of birch allergen immunotherapy on lowest observed adverse effect levels (LOAEL) after soy food challenge in patients with birch-associated and Gly m 4 allergen-mediated soy allergy. Thus, consistently stable Gly m 4 levels were required in standardised challenge meals. METHODS AND RESULTS: Soy meal included soy protein isolate (SPI, 88% total protein). A Gly m 4-specific ELISA was developed and validated...
October 17, 2016: Molecular Nutrition & Food Research
Deborah M Hussey Freeland, Hua Fan-Minogue, Jonathan M Spergel, Talal A Chatila, Kari C Nadeau
The incidence of food allergy, a disease characterized by adverse immune responses that can render common foods life-threatening, is rising. Yet our current standard of care is simply avoidance of allergenic foods and administration of emergency medications upon accidental exposure. Significant advances have been made in food allergy oral immunotherapy, which is emerging as a potential preventive and curative treatment for this disease. The fundamental strategy of oral immunotherapy is to mitigate adverse immune responses to allergenic food proteins through repeated exposure; reduced reactivity to food allergens (desensitization) often results, but the establishment of sustained immune unresponsiveness or of permanent resolution (tolerance) is not certain...
October 13, 2016: Current Opinion in Immunology
Salvatore Chirumbolo
The recent paper by Nucera et al., showed that the basophil activation test (BAT) in flow cytometry is able to monitor an acquired tolerance induced by a desensitization treatment in food allergy. The paper by Nucera et al. reported two standpoints in the CD63 response to food allergy and OAT and their large difference in CD63 response before and after suggests for the optimal performance of a CD123/HLADR/CD63 BAT in oral food allergy immunotherapy.
October 2016: United European Gastroenterology Journal
Ana Brotons-Canto, Nekane Martín-Arbella, Carlos Gamazo, Juan M Irache
Allergic diseases constitute one of the most common causes of chronic illness in developed countries. The main mechanism determining allergy is an imbalance between Th1 and Th2 response towards Th2. Areas covered: This review describes the mechanisms underlying the natural tolerance to food components and the development of an allergic response in sensitized individuals. Furthermore, therapeutic approaches proposed to manage these abnormal immunologic responses food are also presented and discussed. Expert opinion: In the past, management of food allergies has consisted of the education of patients to avoid the ingestion of the culprit food and to initiate the therapy (e...
October 12, 2016: Expert Opinion on Drug Delivery
Aaron K Kobernick, A Wesley Burks
Food allergy has grown in rapidly in prevalence, currently affecting 5% of adults and 8% of children. Management strategy is currently limited to 1) food avoidance and 2) carrying and using rescue intramuscular epinephrine/adrenaline and oral antihistamines in the case of accidental ingestion; there is no FDA approved treatment. Recently, oral, sublingual and epicutaneous immunotherapy have been developed as active treatment of food allergy, though none have completed phase 3 study. Efficacy and safety studies of immunotherapy have been variable, though there is clearly signal that immunotherapy will be a viable option to desensitize patients...
October 2016: Allergology International: Official Journal of the Japanese Society of Allergology
Roxane Labrosse, François Graham, Anne Des Roches, Philippe Bégin
Food allergy is an important health issue that affects up to 8 % of the population. The management of allergic patients involves allergen avoidance and prompts the treatment of accidental reactions, as no curative treatment is available so far in routine practice. Oral immunotherapy (OIT) is a promising therapeutic alternative, but it is associated with frequent allergic reactions and cost-effectiveness issues. In hopes of reducing such reactions, a number of trials have used omalizumab, an anti-IgE monoclonal humanized antibody, as adjunctive therapy in OIT...
September 14, 2016: Archivum Immunologiae et Therapiae Experimentalis
Marie Westwood, Bram Ramaekers, Shona Lang, Nigel Armstrong, Caro Noake, Shelley de Kock, Manuela Joore, Johan Severens, Jos Kleijnen
BACKGROUND: Allergy is a form of immune-mediated exaggerated sensitivity (hypersensitivity) to a substance that is either inhaled, swallowed, injected or comes into contact with the skin. Foreign substances that provoke allergies are called allergens. It has been claimed that multiplex allergen testing may help in diagnosing the cause of symptoms in patients with an unclear cause of allergy or who are allergic to more than one substance. OBJECTIVES: To evaluate multiplex allergen testing [devices that can measure the presence of multiple immunoglobulin E (IgE) antibodies in a patient's blood at the same time], by assessing (1) clinical effectiveness (allergy symptoms, incidence of acute exacerbations, mortality, adverse events of testing and treatment, health-care presentations or admissions, health-related quality of life); (2) effects on treatment (diet, immunotherapy medications, other potential testing); (3) any additional diagnostic information provided by multiplex allergen testing; and (4) cost-effectiveness (cost of different assessment strategies)...
September 2016: Health Technology Assessment: HTA
Matteo Ferrando, Diego Bagnasco, Giovanni Passalacqua, Gilda Varricchi, Giorgio Walter Canonica
INTRODUCTION: Since its introduction in clinical practice one century ago for the treatment of respiratory allergic diseases, allergen-specific immunotherapy (AIT) has exhibited a relevant clinical efficacy that was subsequently confirmed in controlled trials. Thus, AIT has been accepted worldwide, as testified by guidelines and international documents. AIT is considered pivotal in the management of allergic rhinitis with or without conjunctivitis and with or without asthma. These conditions, in addition to hymenoptera venom allergy, currently are the accepted indications...
September 19, 2016: Expert Opinion on Biological Therapy
Yuri Takaoka, Makoto Kameda, Yuko Yajima, Taisuke Tsuji, Tomoki Nishikido, Yukinori Yoshida, Satoru Doi
OBJECTIVE: We performed a constructive study on the effectiveness of oral immunotherapy for wheat allergy using two different intake frequency, and evaluated the impact of intake frequency. SUBJECTS: Of all the subjects who had a positive result in an oral food challenge test for udon (wheat noodles), informed consent was obtained from 49 subjects. Forty-one of the subjects successfully completed testing; data was tabulated for only the 16 in each group who complied with their assigned intake frequency...
August 2016: Arerugī, [Allergy]
Andrew J MacGinnitie, Rima Rachid, Hana Gragg, Sara V Little, Paul Lakin, Antonella Cianferoni, Jennifer Heimall, Melanie Makhija, Rachel Robison, R Sharon Chinthrajah, John Lee, Jennifer Lebovidge, Tina Dominguez, Courtney Rooney, Megan Ott Lewis, Jennifer Koss, Elizabeth Burke-Roberts, Kimberly Chin, Tanya Logvinenko, Jacqueline A Pongracic, Dale T Umetsu, Jonathan Spergel, Kari C Nadeau, Lynda C Schneider
BACKGROUND: Peanut oral immunotherapy is a promising approach to peanut allergy, but reactions are frequent, and some patients cannot be desensitized. The anti-IgE medication omalizumab (Xolair; Genentech, South San Francisco, Calif) might allow more rapid peanut updosing and decrease reactions. OBJECTIVE: We sought to evaluate whether omalizumab facilitated rapid peanut desensitization in highly allergic patients. METHODS: Thirty-seven subjects were randomized to omalizumab (n = 29) or placebo (n = 8)...
September 5, 2016: Journal of Allergy and Clinical Immunology
Masaya Takahashi, Shoichiro Taniuchi, Kazuhiko Soejima, Yasuko Hatano, Sohsaku Yamanouchi, Kazuanri Kaneko
BACKGROUND: Several studies have reported that oral immunotherapy (OIT) is effective for children with cow's milk (CM) allergy. These studies reported the efficacy of OIT in terms of desensitization, but did not describe sustained unresponsiveness to CM. The aim of this study was to evaluate the efficacy of the OIT protocol using microwave heated cow's milk (MH-CM) in terms of 2-weeks-sustained unresponsiveness (2-weeks-SU) and safety. METHODS: Forty-eight children were enrolled in this study...
2016: Allergy, Asthma, and Clinical Immunology
Magnus P Borres, Nobuyuki Maruyama, Sakura Sato, Motohiro Ebisawa
Due to the high prevalence of food allergic diseases globally there are increasing demands in clinical practice for managing IgE-mediated conditions. During the last decade, component resolved diagnostics has been introduced into the field of clinical allergology, providing information that cannot be obtained from extract-based tests. Component resolved data facilitate more precise diagnosis of allergic diseases and identify sensitizations attributable to cross-reactivity. Furthermore it assists risk assessment in clinical practice as sensitization to some allergenic molecules is related to persistence of clinical symptoms and systemic rather than local reactions...
October 2016: Allergology International: Official Journal of the Japanese Society of Allergology
Hiroshi M Ueno, Teruhiko Kato, Hidenori Ohnishi, Norio Kawamoto, Zenichiro Kato, Hideo Kaneko, Naomi Kondo, Taku Nakano
BACKGROUND: Optimally hydrolyzed β-Lactoglobulin (βLg) is a promising milk oral immunotherapy (OIT) candidate with respect to showing reduced B-cell reactivity but retaining the T-cell epitope. To demonstrate that an edible hypoallergenic βLg hydrolysate containing the T-cell epitope is suitable for OIT. We tested how chymotrypsin affected the retention of the T-cell epitope of βLg when preparing βLg hydrolysates using food-grade trypsin. METHODS: We investigated the effect of chymotrypsin activity on the formation of the T-cell epitope-containing peptide of βLg (βLg102-124 ) and prepared an edible βLg hydrolysate containing βLg102-124 using screened food-grade trypsins...
August 19, 2016: Pediatric Allergy and Immunology
Emmanuel Nony, Maxime Le Mignon, Sébastien Brier, Armelle Martelet, Philippe Moingeon
Proteomics encompasses a variety of approaches unraveling both the structural features, post-translational modifications, and abundance of proteins. As of today, proteomic studies have shed light on the primary structure of about 850 allergens, enabling the design of microarrays for improved molecular diagnosis. Proteomic methods including mass spectrometry allow as well to investigate protein-protein interactions, thus yielding precise information on critical epitopes on the surface of allergens. Mass spectrometry is now being applied to the unambiguous identification, characterization, and comprehensive quantification of allergens in a variety of matrices, as diverse as food samples and allergen immunotherapy drug products...
September 2016: Current Allergy and Asthma Reports
Giovanni Passalacqua, Anna Nowak-Węgrzyn, Giorgio Walter Canonica
Sublingual immunotherapy (SLIT) is increasingly used worldwide, and several products have been recently registered as drugs for respiratory allergy by the European Medicine Agency and the Food and Drug Administration. Concerning inhalant allergens, the safety of SLIT is overall superior to that of subcutaneous immunotherapy in terms of systemic adverse events. No fatality has been ever reported, and episodes of anaphylaxis were described only exceptionally. Looking at the historical and recent trials, most (>90%) adverse events are "local" and confined to the site of administration...
August 12, 2016: Journal of Allergy and Clinical Immunology in Practice
Rachel L Peters, Thanh D Dang, Katrina J Allen
Food allergy continues to be a significant public health concern for which there are no approved treatments and management strategies primarily include allergen avoidance and pharmacological measures for accidental exposures. Food allergy is thought to result from either a failure to establish oral tolerance or the breakdown of existing oral tolerance, and therefore, experimental preventative and treatment strategies are now aimed at inducing specific oral tolerance. This may occur in infancy prior to the development of food allergy through the optimal timing of dietary exposure (primary oral tolerance induction) or as a treatment for established food allergy through oral immunotherapy (secondary oral tolerance induction)...
August 6, 2016: Pediatric Allergy and Immunology
Leticia Tordesillas, Lucie Mondoulet, Ana Belen Blazquez, Pierre-Henri Benhamou, Hugh A Sampson, M Cecilia Berin
BACKGROUND: The attempt to induce oral tolerance as a treatment for food allergy has been hampered by a lack of sustained clinical protection. Immunotherapy by nonoral routes, such as the skin, may be more effective for the development of maintained tolerance to food allergens. OBJECTIVE: We sought to determine the efficacy and mechanism of tolerance induced by epicutaneous immunotherapy (EPIT) in a model of food-induced anaphylaxis. METHODS: C3H/HeJ mice were sensitized to ovalbumin (OVA) orally or through the skin and treated with EPIT using OVA-Viaskin patches or oral immunotherapy using OVA...
June 11, 2016: Journal of Allergy and Clinical Immunology
Sangeeta Dhami, Ulugbek Nurmatov, Giovanni Battista Pajno, Montserrat Fernandez-Rivas, Antonella Muraro, Graham Roberts, Cezmi Akdis, Montserrat Alvaro-Lozano, Kirsten Beyer, Carsten Bindslev-Jensen, Wesley Burks, George du Toit, Motohiro Ebisawa, Philippe Eigenmann, Edward Knol, Mika Makela, Kari Christine Nadeau, Liam O'Mahony, Nikolaos Papadopoulos, Lars Poulsen, Cansin Sackesen, Hugh Sampson, Alexandra Santos, Ronald van Ree, Frans Timmermans, Aziz Sheikh
BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated food allergy. We seek to critically assess the effectiveness, cost-effectiveness and safety of AIT in IgE-mediated food allergy. METHODS: We will undertake a systematic review, which will involve searching international biomedical databases for published, in progress and unpublished evidence...
2016: Clinical and Translational Allergy
Elizabeth Feuille, Anna Nowak-Węgrzyn
Oral immunotherapy (OIT) is a promising investigational therapy for food allergy. Clinical trials in peanut, milk, egg, and wheat allergy provide evidence that OIT can effectively desensitize a majority of individuals to a food allergen. While a portion of subjects demonstrate sustained unresponsiveness, the majority regain sensitivity with allergen avoidance. The safety and tolerability of OIT continue to limit its use in some patients. Virtually all studies report adverse reactions that are more frequent during dose escalation but may also occur during maintenance therapy...
2016: Annals of Nutrition & Metabolism
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