An observational study on outgrowing food allergy during non-birch pollen-specific, subcutaneous immunotherapy

Rosaceae food allergy: a review

This review provides a global overview on Rosaceae allergy and details the particularities of each fruit allergy induced by ten Rosaceae species: almond/peach/cherry/apricot/plum (Amygdaleae), apple/pear (Maleae), and raspberry/blackberry/strawberry (Rosoideae). Data on clinical symptoms, prevalence, diagnosis, and immunotherapies for the treatment of Rosaceae allergy are herein stated. Allergen molecular characterization, cross-reactivity/co-sensitization phenomena, the impact of food processing and digestibility, and the methods currently available for the Rosaceae detection/quantification in foods are also described. Rosaceae allergy has a major impact in context to pollen-food allergy syndrome (PFAS) and lipid transfer protein (LTP) allergies, being greatly influenced by geography, environment, and presence of cofactors. Peach, apple, and almond allergies are probably the ones most affecting the quality of life of the allergic-patients, although allergies to other Rosaceae fruits cannot be overlooked. From patients' perspective, self-allergy management and an efficient avoidance of multiple fruits are often difficult to achieve, which might raise the risk for cross-reactivity and co-sensitization phenomena and increase the severity of the induced allergic responses with time. At this point, the absence of effective allergy diagnosis (lack of specific molecular markers) and studies advancing potential immunotherapies are some gaps that certainly will prompt the progress on novel strategies to manage Rosaceae food allergies.

Oral immunotherapy for food allergy: towards a new horizon

Food allergy has increased dramatically in prevalence over the past decade in westernized countries, and is now a major public health problem. Unfortunately for patients with food allergy, there is no effective therapy beyond food allergen avoidance, and rapid medical treatment for accidental exposures. Recently, oral immunotherapy (OIT) has been investigated as a treatment for this problem. In this review, we will discuss the progress in developing OIT for food allergy, including a novel approach utilizing Xolair (anti-IgE monoclonal antibody, omalizumab) in combination with OIT. This combination may enhance both the safety and efficacy of oral immunotherapy, and could lead to a widely available and safe therapy for food allergy.

Food allergy therapy: is a cure within reach?

There is an unmet medical need for an effective food allergy therapy; thus, development of therapeutic interventions for food allergy is a top research priority. The food allergen-nonspecific therapies for food-induced anaphylaxis include monoclonal anti-IgE antibodies and Chinese herbs. The food allergen-specific therapies include oral, sublingual, and epicutaneous immunotherapy with native food allergens and mutated recombinant proteins. Diet containing heated milk and egg may represent an alternative approach to oral immunomodulation. Oral food immunotherapy remains an investigational treatment to be further studied before advancing into clinical practice.

Future therapies for food allergies

Food allergy is an increasingly prevalent problem in westernized countries, and there is an unmet medical need for an effective form of therapy. A number of therapeutic strategies are under investigation targeting foods that most frequently provoke severe IgE-mediated anaphylactic reactions (peanut, tree nuts, and shellfish) or are most common in children, such as cow's milk and hen's egg. Approaches being pursued are both food allergen specific and nonspecific. Allergen-specific approaches include oral, sublingual, and epicutaneous immunotherapy (desensitization) with native food allergens and mutated recombinant proteins, which have decreased IgE-binding activity, coadministered within heat-killed Escherichia coli to generate maximum immune response. Diets containing extensively heated (baked) milk and egg represent an alternative approach to food oral immunotherapy and are already changing the paradigm of strict dietary avoidance for patients with food allergy. Nonspecific approaches include monoclonal anti-IgE antibodies, which might increase the threshold dose for food allergen in patients with food allergy, and a Chinese herbal formulation, which prevented peanut-induced anaphylaxis in a murine model and is currently being investigated in clinical trials. The variety of strategies for treating food allergy increases the likelihood of success and gives hope that accomplishing an effective therapy for food allergy is within reach.

Immunologic therapeutic approaches in the management of food allergy

Food allergy affects up to 6% of children and 3-4% of adults in Westernized countries, and is the most common cause of outpatient anaphylaxis in most studies. The mainstay of treatment is strict avoidance of the offending allergens and education regarding the use of emergency medication in cases of accidental ingestions or exposures. While these approaches are generally effective, there are no definitive treatments that cure or provide long-term remission from food allergy. However, with recent advances in characterizing food allergens and understanding humoral and cellular immune responses in food allergy, several therapeutic strategies are being investigated. Potential treatments include allergen-specific immunotherapy as well as allergen-nonspecific approaches to downregulate the overall allergic response in food-allergic individuals.

Food allergy: recent advances in pathophysiology and treatment

Food allergies are adverse immune reactions to food proteins that affect up to 6% of children and 3-4% of adults. A wide range of symptoms can occur depending on whether IgE or non-IgE mediated mechanism are involved. Many factors influence the development of oral tolerance, including route of exposure, genetics, age of the host, and allergen factors. Advances have been made in the understanding of how these factors interact in the pathophysiology of food allergy. Currently, the mainstay of treatment for food allergies is avoidance and ready access to emergency medications. However, with the improved understanding of tolerance and advances in characterization of food allergens, several therapeutic strategies have been developed and are currently being investigated as potential treatments and/or cures for food allergy.

A structural basis for food allergy: the role of cross-reactivity

PURPOSE OF REVIEW

Immunologic cross-reactivity, which is important in many aspects of host defense and immune-mediated diseases, is a prominent feature of allergic disorders. The goal of this article is to define allergenic cross-reactivity and its role in food allergy, review current understanding of mechanisms of cross-reactivity, and consider how advances in our ability to predict cross-reactivity can impact diagnosis and treatment of food allergy.

RECENT FINDINGS

Recent evidence suggests that specific T cells, in addition to IgE, developed in response to inhaled allergens can cross-react with related food allergens, leading to distinct clinical reactions. Several new cross-reactivities have been identified, including food-food, pollen-food, and latex-venom associations. Debate continues regarding prediction of allergenicity based on protein structure, and clinical relevance of in-vitro testing. Cross-reactivity is also being used to develop specific immunotherapy for treatment of food allergy.

SUMMARY

A thorough understanding of immunologic cross-reactivity is essential to advancing our knowledge about food allergy. This knowledge will help elucidate the pathogenesis of the disorder and prevent exposures to allergenic, genetically engineered foods. New insight will allow for better utilization of current diagnostic tools and the development of more accurate tests and therapies for food allergy.

Asthma and food allergy

PURPOSE OF REVIEW

Food allergy associated clinical and social burdens have increased substantially in prevalence in the past decade. Coexisting asthma is a significant problem as food reactions tend to be more severe when they involve the lung. Food allergy also increases asthma morbidity in adults and children.

RECENT FINDINGS

Especially in early infancy, food allergy can be related to the development of future asthma. For diagnosis, cut-off values are very important for both specific IgE levels and skin-prick test when interpreting food allergy. For the treatment, oral immunotherapy is showing promise for refractory patients with IgE-mediated food allergies.

SUMMARY

Food allergies can be classified as IgE-mediated or non-IgE-mediated. Besides foods, some additives and preservatives can also trigger asthma in certain people. Asthma may develop in about 5% of individuals who suffer from food allergy and current asthma may be triggered by foods among 6-8% of children and 2% of adults. Because of the difficulty of confirming diagnosis of food allergy, novel approaches are currently being investigated and new therapy modalities are being sought. For total asthma control and for better quality of life, steps should be taken to avoid foods in cases of food allergy.