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Vonk MM, Diks MAP, Wagenaar L, Smit JJ, Pieters RHH, Garssen J, van Esch BCAM, Knippels LMJ. Improved Efficacy of Oral Immunotherapy Using Non-Digestible Oligosaccharides in a Murine Cow's Milk Allergy Model: A Potential Role for Foxp3+ Regulatory T Cells. Front Immunol 2017; 8:1230. [PMID: 29033945 PMCID: PMC5626810 DOI: 10.3389/fimmu.2017.01230] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/19/2017] [Indexed: 01/05/2023] Open
Abstract
Background Oral immunotherapy (OIT) is a promising therapeutic approach to treat food allergic patients. However, there are some concerns regarding its safety and long-term efficacy. The use of non-digestible oligosaccharides might improve OIT efficacy since they are known to directly modulate intestinal epithelial and immune cells in addition to acting as prebiotics. Aim To investigate whether a diet supplemented with plant-derived fructo-oligosaccharides (FOS) supports the efficacy of OIT in a murine cow’s milk allergy model and to elucidate the potential mechanisms involved. Methods After oral sensitization to the cow’s milk protein whey, female C3H/HeOuJ mice were fed either a control diet or a diet supplemented with FOS (1% w/w) and received OIT (10 mg whey) 5 days a week for 3 weeks by gavage. Intradermal (i.d.) and intragastric (i.g.) challenges were performed to measure acute allergic symptoms and mast cell degranulation. Blood and organs were collected to measure antibody levels and T cell and dendritic cell populations. Spleen-derived T cell fractions (whole spleen- and CD25-depleted) were transferred to naïve recipient mice to confirm the involvement of regulatory T cells (Tregs) in allergy protection induced by OIT + FOS. Results OIT + FOS decreased acute allergic symptoms and mast cell degranulation upon challenge and prevented the challenge-induced increase in whey-specific IgE as observed in sensitized mice. Early induction of Tregs in the mesenteric lymph nodes (MLN) of OIT + FOS mice coincided with reduced T cell responsiveness in splenocyte cultures. CD25 depletion in OIT + FOS-derived splenocyte suspensions prior to transfer abolished protection against signs of anaphylaxis in recipients. OIT + FOS increased serum galectin-9 levels. No differences in short-chain fatty acid (SCFA) levels in the cecum were observed between the treatment groups. Concisely, FOS supplementation significantly improved OIT in the acute allergic skin response, %Foxp3+ Tregs and %LAP+ Th3 cells in MLN, and serum galectin-9 levels. Conclusion FOS supplementation improved the efficacy of OIT in cow’s milk allergic mice. Increased levels of Tregs in the MLN and abolished protection against signs of anaphylaxis upon transfer of CD25-depleted cell fractions, suggest a role for Foxp3+ Tregs in the protective effect of OIT + FOS.
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Affiliation(s)
- Marlotte M Vonk
- Faculty of Science, Department of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.,Immunology Platform, Nutricia Research, Utrecht, Netherlands
| | - Mara A P Diks
- Faculty of Science, Department of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Laura Wagenaar
- Faculty of Veterinary Medicine, Department of Immunotoxicology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Joost J Smit
- Faculty of Veterinary Medicine, Department of Immunotoxicology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Raymond H H Pieters
- Faculty of Veterinary Medicine, Department of Immunotoxicology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Johan Garssen
- Faculty of Science, Department of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.,Immunology Platform, Nutricia Research, Utrecht, Netherlands
| | - Betty C A M van Esch
- Faculty of Science, Department of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.,Immunology Platform, Nutricia Research, Utrecht, Netherlands
| | - Léon M J Knippels
- Faculty of Science, Department of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.,Immunology Platform, Nutricia Research, Utrecht, Netherlands
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Srivastava KD, Song Y, Yang N, Liu C, Goldberg IE, Nowak-Węgrzyn A, Sampson HA, Li XM. B-FAHF-2 plus oral immunotherapy (OIT) is safer and more effective than OIT alone in a murine model of concurrent peanut/tree nut allergy. Clin Exp Allergy 2017; 47:1038-1049. [PMID: 28397379 PMCID: PMC5533629 DOI: 10.1111/cea.12936] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Concurrent sensitization to peanut (PN) and tree nuts (TN), the most dangerous food allergies, is common. Current oral immunotherapy (OIT) is not fully satisfactory. OBJECTIVE To determine whether the herbal formula B-FAHF-2 (BF2) ameliorates PN/TN OIT adverse reactions and enhances persistence of a tolerant state. METHODS Concurrently sensitized PN-, walnut- (WN) and cashew (CSH)-allergic mice received 1-day PN/WN/CSH rush OIT plus 3 weeks of maintenance dosing, with or without 3 weeks prior and 3 weeks BF2 co-treatment. Anaphylactic symptom scores, core body temperatures, plasma histamine levels, basophil numbers, antigen-specific IgE, cytokine levels, and IL-4, INF-γ and Foxp3 gene promoter DNA methylation status, and their correlation with final challenge symptom scores were determined. RESULTS BF2+OIT-treated mice experienced significantly fewer and less severe adverse reactions than OIT-only-treated mice (P<.01) during the 1-day rush OIT build-up dose phase. Both OIT-only and BF2+OIT mice showed significant desensitization (P<.01 and .001, respectively) at 1 week post-therapy challenge, being greater in BF2+OIT mice. All sham-treated and 91% of OIT-treated mice experienced anaphylaxis whereas only 21% of BF2+OIT-treated mice exhibited reactions during 5-6 weeks of dose escalation single PN and TN challenges. Greater and more persistent protection in BF2+OIT mice was associated with significantly lower plasma histamine and IgE levels, increased IFN-γ/IL-4 and IL-10/IL-4 ratios, DNA remethylation at the IL-4 promoter and demethylation at IFN-γ and Foxp3 promoters. Final challenge symptom scores were inversely correlated with IL-4 DNA methylation levels (P<.0002) and positively correlated with IFN-γ and Foxp3 gene promoter methylation levels (P<.0011) (P<.0165). CONCLUSIONS AND CLINICAL RELEVANCE Combined BF2/OIT therapy was safer and produced longer post-treatment protection and more tolerance-prone immunological and epigenetic modifications than OIT alone. BF2/OIT may provide an additional OIT option for patients with concurrent PN/TN and other food allergies.
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Affiliation(s)
- K D Srivastava
- Department of Pediatrics, Jaffe Food Allergy Institute, Center for Integrative Medicine for Immunology and Wellness, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Song
- Department of Pediatrics, Jaffe Food Allergy Institute, Center for Integrative Medicine for Immunology and Wellness, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Yang
- Department of Pediatrics, Jaffe Food Allergy Institute, Center for Integrative Medicine for Immunology and Wellness, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Liu
- Department of Pediatrics, Jaffe Food Allergy Institute, Center for Integrative Medicine for Immunology and Wellness, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - I E Goldberg
- Department of Pediatrics, Jaffe Food Allergy Institute, Center for Integrative Medicine for Immunology and Wellness, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Nowak-Węgrzyn
- Department of Pediatrics, Jaffe Food Allergy Institute, Center for Integrative Medicine for Immunology and Wellness, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - H A Sampson
- Department of Pediatrics, Jaffe Food Allergy Institute, Center for Integrative Medicine for Immunology and Wellness, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - X-M Li
- Department of Pediatrics, Jaffe Food Allergy Institute, Center for Integrative Medicine for Immunology and Wellness, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Martorell A, Alonso E, Echeverría L, Escudero C, García-Rodríguez R, Blasco C, Bone J, Borja-Segade J, Bracamonte T, Claver A, Corzo JL, De la Hoz B, Del Olmo R, Dominguez O, Fuentes-Aparicio V, Guallar I, Larramona H, Martín-Muñoz F, Matheu V, Michavila A, Ojeda I, Ojeda P, Piquer M, Poza P, Reche M, Rodríguez Del Río P, Rodríguez M, Ruano F, Sánchez-García S, Terrados S, Valdesoiro L, Vazquez-Ortiz M. Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase. Allergol Immunopathol (Madr) 2017; 45:393-404. [PMID: 28662773 DOI: 10.1016/j.aller.2017.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/19/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.
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Affiliation(s)
- A Martorell
- Department of Allergology, University General Hospital, Valencia, Spain.
| | - E Alonso
- Department of Pediatric Allergy, Gregorio Marañón Hospital, Madrid, Spain
| | - L Echeverría
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - C Escudero
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - R García-Rodríguez
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - C Blasco
- Department of Pediatric Allergy, Vall d'Hebron Hospital, Barcelona, Spain
| | - J Bone
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - J Borja-Segade
- Department of Allergology, University General Hospital, Ciudad Real, Spain
| | - T Bracamonte
- Department of Pediatric Allergy, Severo Ochoa University Hospital, Leganés, Spain
| | - A Claver
- Quirón Dexeus University Hospital, Barcelona, Spain
| | - J L Corzo
- Department of Pediatric Allergy, Carlos Haya University Hospital, Málaga, Spain
| | - B De la Hoz
- Department of Allergology, Ramón y Cajal Hospital, Madrid, Spain
| | - R Del Olmo
- Department of Pediatric Allergy, University Hospital, Móstoles, Spain
| | - O Dominguez
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | | | - I Guallar
- Department of Pediatric Allergy, Miguel Servet University Hospital, Zaragoza, Spain
| | - H Larramona
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - F Martín-Muñoz
- Department of Allergology, La Paz Children's Hospital, Madrid, Spain
| | - V Matheu
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - A Michavila
- Department of Pediatric Allergy, General Hospital, Castellón, Spain
| | | | | | - M Piquer
- Department of Pediatric Allergy, San Joan de Deu Hospital, Barcelona, Spain
| | - P Poza
- Allergology Unit-North Chest Hospital, Santa Cruz de Tenerife, Spain
| | - M Reche
- Department of Allergology, Infanta Sofía Hospital, San Sebastián de los Reyes, Spain
| | - P Rodríguez Del Río
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - M Rodríguez
- Department of Allergology, Alcorcón Foundation Hospital, Alcorcón, Spain
| | - F Ruano
- Department of Allergy, Infanta Leonor Hospital, Madrid, Spain
| | - S Sánchez-García
- Department of Pediatric Allergy, Niño Jesús University Children's Hospital, Madrid, Spain
| | - S Terrados
- Department of Pediatric Allergy, Ramón y Cajal Hospital, Madrid, Spain
| | - L Valdesoiro
- Department of Pediatric Allergy, Parc Taulí University Hospital, Sabadell, Spain
| | - M Vazquez-Ortiz
- Pediatric Allergy, Department of Medicine, Imperial College London, United Kingdom
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Mori F, Cianferoni A, Brambilla A, Barni S, Sarti L, Pucci N, de Martino M, Novembre E. Side effects and their impact on the success of milk oral immunotherapy (OIT) in children. Int J Immunopathol Pharmacol 2017; 30:182-187. [PMID: 28466667 PMCID: PMC5806791 DOI: 10.1177/0394632017697986] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oral immunotherapy (OIT) has been introduced as a new immune-modulating treatment under investigation for food allergies. The aim of our study was to evaluate the success of OIT in a cohort of children with milk allergy. These children underwent OIT in a clinical practice and were followed for up to ten years. The secondary endpoint was to describe the main adverse events during OIT and compare them to those reported in the literature. Eighty-two milk-allergic children started OIT. According to the OIT endpoint reached after one year, all of the children enrolled in the study were divided into four groups: complete desensitization; partial desensitization; step down; and stop groups. Any adverse events that occurred during OIT were also recorded. Of the 82 patients, eight were recruited in the last months of 2010 so they were still ongoing at the end of the study. For that reason, they were excluded from the analysis. The majority (73%) of the 74 children evaluated (51 boys, 23 girls; median age, 7 years; age range, 2–18 years; specific serum IgE for cow’s milk, 36 KUA/L [range, 3–100 KUA/L]; milk SPT wheal diameter, 7 mm [range, 2–15 mm]) reached complete (58.1%) or partial (14.9%) desensitization, 9.4% were subjected to step down. The remaining 17.6% of the children discontinued OIT because of the occurrence of chronic gastroenteric (GE) symptoms (46.1%) or acute asthma (15.3%) following milk intake. In agreement with the literature, we found that chronic GE symptoms was the main reason for OIT discontinuation. OIT represents a valid tool for the treatment of food allergies in children; however, the risk of potential adverse reactions, both IgE- and non-IgE-mediated, should be discussed with parents prior to the initiation of OIT.
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Affiliation(s)
- Francesca Mori
- 1 Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Antonella Cianferoni
- 2 Allergy and Immunology Division, The Children's Hospital of Philadelphia, PA, USA
| | - Alice Brambilla
- 1 Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Simona Barni
- 1 Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Lucrezia Sarti
- 1 Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Neri Pucci
- 1 Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- 3 Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elio Novembre
- 1 Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
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Yanagida N, Sato S, Asaumi T, Nagakura K, Ogura K, Ebisawa M. Safety and Efficacy of Low-Dose Oral Immunotherapy for Hen's Egg Allergy in Children. Int Arch Allergy Immunol 2017; 171:265-268. [DOI: 10.1159/000454807] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022] Open
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Shik D, Tomar S, Lee JB, Chen CY, Smith A, Wang YH. IL-9-producing cells in the development of IgE-mediated food allergy. Semin Immunopathol 2017; 39:69-77. [PMID: 27909880 PMCID: PMC5225002 DOI: 10.1007/s00281-016-0605-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
Food allergy is a harmful immune reaction driven by uncontrolled type 2 immune responses. Considerable evidence demonstrates the key roles of mast cells, IgE, and TH2 cytokines in mediating food allergy. However, this evidence provides limited insight into why only some, rather than all, food allergic individuals are prone to develop life-threatening anaphylaxis. Clinical observations suggest that patients sensitized to food through the skin early in life may later develop severe food allergies. Aberrant epidermal thymic stromal lymphopoietin and interleukin (IL) 33 production and genetic predisposition can initiate an allergic immune response mediated by dendritic cells and CD4+TH2 cells in inflamed skin. After allergic sensitization, intestinal IL-25 and food ingestion enhance concerted interactions between type 2 innate lymphoid cells (ILC2s) and CD4+TH2 cells, which perpetuate allergic reactions from the skin to the gut. IL-4 and cross-linking of antigen/IgE/FcεR complexes induce emigrated mast cell progenitors to develop into the multi-functional IL-9-producing mucosal mast cells, which produce prodigious amounts of IL-9 and mast cell mediators to drive intestinal mastocytosis in an autocrine loop. ILC2s and TH9 cells may also serve as alternative cellular sources of IL-9 to augment the amplification of intestinal mastocytosis, which is the key cellular checkpoint in developing systemic anaphylaxis. These findings provide a plausible view of how food allergy develops and progresses in a stepwise manner and that atopic signals, dietary allergen ingestion, and inflammatory cues are fundamental in promoting life-threatening anaphylaxis. This information will aid in improving diagnosis and developing more effective therapies for food allergy-triggered anaphylaxis.
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Affiliation(s)
- Dana Shik
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Sunil Tomar
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Jee-Boong Lee
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon, 34141, South Korea
| | - Chun-Yu Chen
- Division of Hematology/Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, 43205, USA
| | - Andrew Smith
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Yui-Hsi Wang
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Burnet Avenue, Cincinnati, OH, 45229, USA.
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Aricigil M, Muluk NB, Sakarya EU, Sakalar EG, Senturk M, Reisacher WR, Cingi C. New Routes of Allergen Immunotherapy. Am J Rhinol Allergy 2016; 30:193-197. [DOI: 10.2500/ajra.2016.30.4379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives Allergen immunotherapy is the only cure for immunoglobulin E mediated type I respiratory allergies. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are the most common treatments. In this article, we reviewed new routes of allergen immunotherapy. Methods Data on alternative routes to allow intralymphatic immunotherapy (ILIT), epicutaneous immunotherapy (EPIT), local nasal immunotherapy (LNIT), oral immunotherapy (OIT), and oral mucosal immunotherapy (OMIT) were gathered from the literature and were discussed. Results ILIT features direct injection of allergens into lymph nodes. ILIT may be clinically effective after only a few injections and induces allergen-specific immunoglobulin G, similarly to SCIT. A limitation of ILIT is that intralymphatic injections are required. EPIT features allergen administration by using patches mounted on the skin. EPIT seeks to target epidermal antigen–presenting Langerhans cells rather than mast cells or the vasculature; this should reduce both local and systemic adverse effects. LNIT involves the spraying of allergen extracts into the nasal cavity. Natural or chemically modified allergens (the latter, termed allergoids, lack immunoglobulin E reactivity) are prepared in a soluble form. OIT involves the regular administration of small amounts of a food allergen by mouth and commences with low oral doses, which are then increased as tolerance develops. OMIT seeks to deliver allergenic proteins to an expanded population of Langerhans cells in the mucosa of the oral cavity. Conclusions ILIT, EPIT, LNIT, OIT, and OMIT are new routes for allergen immunotherapy. They are safe and effective.
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Affiliation(s)
- Mitat Aricigil
- ENT Department, Meram Medical Faculty, Necmettin Erbakan University, Konya Turkey
| | - Nuray Bayar Muluk
- Department of Otorhinolaryngology, Medical Faculty, Kirikkale University, Kirikkale, Turkey
| | | | | | - Mehmet Senturk
- ENT Clinics, Konya Training and Research Hospital, Konya, Turkey
| | | | - Cemal Cingi
- Department of Otorhinolaryngology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
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Iweala OI, Burks AW. Food Allergy: Our Evolving Understanding of Its Pathogenesis, Prevention, and Treatment. Curr Allergy Asthma Rep 2016; 16:37. [PMID: 27041704 DOI: 10.1007/s11882-016-0616-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Food allergy is defined as an IgE-mediated hypersensitivity response to ingested food with allergic symptoms ranging from urticaria to life-threatening anaphylaxis. Food allergy is thought to develop because of (1) failed induction of tolerance upon initial exposure to food antigen or (2) breakdown of established tolerance to food antigen. We review current understanding of the pathogenesis, epidemiology, and natural history of food allergy, including the unconventional IgE-mediated food allergy to mammalian meat known as alpha-gal food allergy. We highlight emerging data on food allergy treatment and prevention, emphasizing the growing appeal of manipulating the gut microenvironment using probiotics and helminth products to blunt systemic allergic responses to food.
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Affiliation(s)
- Onyinye I Iweala
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina School of Medicine, 030 MacNider Hall, CB 7231, Chapel Hill, NC, 27599-7231, USA.
| | - A Wesley Burks
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, University of North Carolina School of Medicine, 030 MacNider Hall, CB 7231, Chapel Hill, NC, 27599-7231, USA
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59
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Comparisons of outcomes with food immunotherapy strategies: efficacy, dosing, adverse effects, and tolerance. Curr Opin Allergy Clin Immunol 2016; 16:396-403. [DOI: 10.1097/aci.0000000000000290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tao B, Bernardo K, Eldi P, Chegeni N, Wiese M, Colella A, Kral A, Hayball J, Smith W, Forsyth K, Chataway T. Extended boiling of peanut progressively reduces IgE allergenicity while retaining T cell reactivity. Clin Exp Allergy 2016; 46:1004-14. [DOI: 10.1111/cea.12740] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/09/2016] [Accepted: 03/31/2016] [Indexed: 11/30/2022]
Affiliation(s)
- B. Tao
- Department of Paediatrics and Child Health; Flinders University of South Australia; Adelaide SA Australia
- Flinders Proteomics Facility; Department of Human Physiology; Flinders University of South Australia; Adelaide SA Australia
| | - K. Bernardo
- Flinders Proteomics Facility; Department of Human Physiology; Flinders University of South Australia; Adelaide SA Australia
| | - P. Eldi
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide SA Australia
| | - N. Chegeni
- Flinders Proteomics Facility; Department of Human Physiology; Flinders University of South Australia; Adelaide SA Australia
| | - M. Wiese
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide SA Australia
| | - A. Colella
- Department of Immunology; Flinders University of South Australia; Adelaide SA Australia
| | - A. Kral
- Department and School of Medicine; University of Adelaide; Adelaide SA Australia
| | - J. Hayball
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide SA Australia
| | - W. Smith
- Department and School of Medicine; University of Adelaide; Adelaide SA Australia
| | - K. Forsyth
- Department of Paediatrics and Child Health; Flinders University of South Australia; Adelaide SA Australia
| | - T. Chataway
- Flinders Proteomics Facility; Department of Human Physiology; Flinders University of South Australia; Adelaide SA Australia
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61
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Vazquez-Ortiz M, Turner PJ. Improving the safety of oral immunotherapy for food allergy. Pediatr Allergy Immunol 2016; 27:117-25. [PMID: 26593873 PMCID: PMC4950028 DOI: 10.1111/pai.12510] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 12/11/2022]
Abstract
Food allergy is a major public health problem in children, impacting upon the affected individual, their families and others charged with their care, for example educational establishments, and the food industry. In contrast to most other paediatric diseases, there is no established cure: current management is based upon dietary avoidance and the provision of rescue medication in the event of accidental reactions, which are common. This strategy has significant limitations and impacts adversely on health-related quality of life. In the last decade, research into disease-modifying treatments for food allergy has emerged, predominantly for peanut, egg and cow's milk. Most studies have used the oral route (oral immunotherapy, OIT), in which increasing amounts of allergen are given over weeks-months. OIT has proven effective to induce immune modulation and 'desensitization' - that is, an increase in the amount of food allergen that can be consumed, so long as regular (typically daily) doses are continued. However, its ability to induce permanent tolerance once ongoing exposure has stopped seems limited. Additionally, the short- and long-term safety of OIT is often poorly reported, raising concerns about its implementation in routine practice. Most patients experience allergic reactions and, although generally mild, severe reactions have occurred. Long-term adherence is unclear, which rises concerns given the low rates of long-term tolerance induction. Current research focuses on improving current limitations, especially safety. Strategies include alternative routes (sublingual, epicutaneous), modified hypoallergenic products and adjuvants (anti-IgE, pre-/probiotics). Biomarkers of safe/successful OIT are also under investigation.
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Affiliation(s)
| | - Paul J Turner
- Section of Paediatrics, Imperial College London, London, UK.,Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, NSW, Australia
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