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Todoric K, Merrill S. Oral Immunotherapy: An Overview. Med Clin North Am 2024; 108:719-731. [PMID: 38816113 DOI: 10.1016/j.mcna.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Oral immunotherapy (OIT) is an alternative treatment of IgE-mediated food allergy that has been shown to increase tolerance threshold to many of the top food allergens, although this effect may be dependent on age, dose, frequency, and duration. OIT has been shown to be effective and safe in infants, and early initiation can improve rates of desensitization even for those foods whose natural history favors loss of allergy. Studies looking at protocol modification to improve OIT success are ongoing as is the evaluation of clinical tools to help monitor OIT effects.
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Affiliation(s)
- Krista Todoric
- Medical Arts Allergy, 220 Wilson Street Suite 200, Carlisle, PA 17013, USA.
| | - Sarah Merrill
- Family Medicine Department, UC San Diego Health, 402 Dickinson Street, San Diego, CA 92103, USA
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2
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Barten LJC, Zuurveld M, Faber J, Garssen J, Klok T. Oral immunotherapy as a curative treatment for food-allergic preschool children: Current evidence and potential underlying mechanisms. Pediatr Allergy Immunol 2023; 34:e14043. [PMID: 38010006 DOI: 10.1111/pai.14043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023]
Abstract
The worldwide rising prevalence of food allergy is a major public health concern. Standard care consists of allergen avoidance and rescue medication upon accidental exposure. Oral immunotherapy (OIT) is increasingly being studied as a treatment option. Although desensitization (an increased reaction threshold) is often achieved during OIT, sustained unresponsiveness (SU; clinical nonreactivity after finishing OIT) is not achieved in most patients. A few studies have investigated the effectiveness of OIT in children younger than 4 years of age (early = e-OIT) and have shown a much more favorable outcome in terms of SU development. Together with food allergy prevention studies, which have demonstrated high efficacy of early oral allergen exposure, the outcomes of e-OIT studies indicate an early-life window of opportunity to achieve SU, allowing unrestricted dietary intake. However, the underlying mechanism of the high effectiveness of e-OIT is not understood yet. Both cohort and OIT studies indicate early-life immune plasticity. An immature food-allergic response in the first years of life seems to be a major driver of this immune plasticity, along with a higher tolerogenic immunological state. Allergy maturation can likely be disrupted effectively by early intervention, preventing the development of persistent food allergy. Upcoming studies will provide important additional data on the safety, feasibility, and effectiveness of e-OIT. Combined with immune mechanistic studies, this should inform the implementation of e-OIT.
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Affiliation(s)
- Lieke J C Barten
- Pediatric Allergy Treatment Center, Deventer Hospital, Deventer, The Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Division Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Marit Zuurveld
- Utrecht Institute for Pharmaceutical Sciences, Division Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Joyce Faber
- Pediatric Allergy Treatment Center, Deventer Hospital, Deventer, The Netherlands
| | - Johan Garssen
- Utrecht Institute for Pharmaceutical Sciences, Division Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Ted Klok
- Pediatric Allergy Treatment Center, Deventer Hospital, Deventer, The Netherlands
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3
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Abstract
Oral immunotherapy (OIT) is an alternative treatment of IgE-mediated food allergy that has been shown to increase tolerance threshold to many of the top food allergens, although this effect may be dependent on age, dose, frequency, and duration. OIT has been shown to be effective and safe in infants, and early initiation can improve rates of desensitization even for those foods whose natural history favors loss of allergy. Studies looking at protocol modification to improve OIT success are ongoing as is the evaluation of clinical tools to help monitor OIT effects.
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4
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Rana J, Muñoz MM, Biswas M. Oral tolerance to prevent anti-drug antibody formation in protein replacement therapies. Cell Immunol 2022; 382:104641. [PMID: 36402002 PMCID: PMC9730862 DOI: 10.1016/j.cellimm.2022.104641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Protein based therapeutics have successfully improved the quality of life for patients of monogenic disorders like hemophilia, Pompe and Fabry disease. However, a significant proportion of patients develop immune responses towards intravenously infused therapeutic protein, which can complicate or neutralize treatment and compromise patient safety. Strategies aimed at circumventing immune responses following therapeutic protein infusion can greatly improve therapeutic efficacy. In recent years, antigen-based oral tolerance induction has shown promising results in the prevention and treatment of autoimmune diseases, food allergies and can prevent anti-drug antibody formation to protein replacement therapies. Oral tolerance exploits regulatory mechanisms that are initiated in the gut associated lymphoid tissue (GALT) to promote active suppression of orally ingested antigen. In this review, we outline general perceptions and current knowledge about the mechanisms of oral tolerance, including tissue specific sites of tolerance induction and the cells involved, with emphasis on antigen presenting cells and regulatory T cells. We define several factors, such as cytokines and metabolites that impact the stability and expansion potential of these immune modulatory cells. We highlight preclinical studies that have been performed to induce oral tolerance to therapeutic proteins or enzymes for single gene disorders, such as hemophilia or Pompe disease. These studies mainly utilize a transgenic plant-based system for oral delivery of antigen in conjugation with fusion protein technology that favors the prevention of antigen degradation in the stomach while enhancing uptake in the small intestine by antigen presenting cells and regulatory T cell induction, thereby promoting antigen specific systemic tolerance.
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Affiliation(s)
- Jyoti Rana
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maite Melero Muñoz
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Moanaro Biswas
- Herman B Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
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5
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Yang J, Kuang H, Xiong X, Li N, Song J. Alteration of the allergenicity of cow's milk proteins using different food processing modifications. Crit Rev Food Sci Nutr 2022; 64:4622-4642. [PMID: 36377678 DOI: 10.1080/10408398.2022.2144792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Milk is an essential source of protein for infants and young children. At the same time, cow's milk is also one of the most common allergenic foods causing food allergies in children. Recently, cow's milk allergy (CMA) has become a common public health issue worldwide. Modern food processing technologies have been developed to reduce the allergenicity of milk proteins and improve the quality of life of patients with CMA. In this review, we summarize the main allergens in cow's milk, and introduce the recent findings on CMA responses. Moreover, the reduced effects and underlying mechanisms of different food processing techniques (such as heating, high pressure, γ-ray irradiation, ultrasound irradiation, hydrolysis, glycosylation, etc.) on the allergenicity of cow's milk proteins, and the application of processed cow's milk in clinical studies, are discussed. In addition, we describe the changes of nutritional value in cow's milk treated by different food processing technologies. This review provides an in-depth understanding of the allergenicity reduction of cow's milk proteins by various food processing techniques.
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Affiliation(s)
- Jing Yang
- Chongqing Engineering Research Center for Processing & Storage of Distinct Agricultural Products, Chongqing Technology and Business University, Chongqing, China
- College of Modern Industry for Nutrition & Health, Chongqing Technology and Business University, Chongqing, China
| | - Hong Kuang
- Chongqing Engineering Research Center for Processing & Storage of Distinct Agricultural Products, Chongqing Technology and Business University, Chongqing, China
| | - Xiaoli Xiong
- Chongqing Engineering Research Center for Processing & Storage of Distinct Agricultural Products, Chongqing Technology and Business University, Chongqing, China
| | - Ning Li
- Chongqing Engineering Research Center for Processing & Storage of Distinct Agricultural Products, Chongqing Technology and Business University, Chongqing, China
| | - Jiajia Song
- College of Food Science, Southwest University, Chongqing, China
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6
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Tang L, Yu Y, Pu X, Chen J. Oral immunotherapy for Immunoglobulin E-mediated cow's milk allergy in children: A systematic review and meta analysis. Immun Inflamm Dis 2022; 10:e704. [PMID: 36169249 PMCID: PMC9476891 DOI: 10.1002/iid3.704] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGOUND Cow's milk allergy (CMA) is the most common allergy in infants that decreases the quality of life of patients and their families. Standard treatment for CMA is the strict avoidance of milk; new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA. We aimed to assess the clinical efficacy and safety of OIT in the treatment of children with immunoglobulin E-mediated CMA (IMCMA). METHODS We searched all randomized controlled trials in which OIT is used to treat children with IMCMA from five international electronic databases. We estimated a pooled risk ratio (RR) for each outcome using a Mantel-Haenzel fixed-effects model if statistical heterogeneity was low. RESULTS Eleven studies were chosen for meta-analysis, including a total of 469 children (242 OITs, 227 controls). One hundred and seventy-six patients (72.7%) in the OIT were desensitized compared with 49 patients (21.6%) in the control group (RR: 7.35, 95% confidence interval (CI): 2.82-19.13, p < .0001). The desensitization effect of OIT was particularly significant in children over 3 years old (RR: 18.05, 95% CI: 6.48-50.26, p < .00001). Although adverse effects were common, they usually involved mild reactions, but epinephrine use was more common in the OIT group (RR: 7.69, 95% CI: 2.16-27.33, p < .002). CONCLUSION OIT can lead to desensitization in the majority of individuals with IMCMA, especially in patients over 3 years old. A major problem of OIT is the frequency of adverse events, although most are mild. OIT may be an alternative treatment in the future.
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Affiliation(s)
- Lujing Tang
- Department of Gastroenterology, The Children's Hospital, Zhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouChina
| | - Yu Yu
- Department of Gastroenterology, The Children's Hospital, Zhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouChina
| | - Xiangyuan Pu
- Department of CardiologyFirst Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Jie Chen
- Department of Gastroenterology, The Children's Hospital, Zhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouChina
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Zhu H, Tang K, Chen G, Liu Z. Biomarkers in oral immunotherapy. J Zhejiang Univ Sci B 2022; 23:705-731. [PMID: 36111569 PMCID: PMC9483607 DOI: 10.1631/jzus.b2200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Food allergy (FA) is a global health problem that affects a large population, and thus effective treatment is highly desirable. Oral immunotherapy (OIT) has been showing reasonable efficacy and favorable safety in most FA subjects. Dependable biomarkers are needed for treatment assessment and outcome prediction during OIT. Several immunological indicators have been used as biomarkers in OIT, such as skin prick tests, basophil and mast cell reactivity, T cell and B cell responses, allergen-specific antibody levels, and cytokines. Other novel indicators also could be potential biomarkers. In this review, we discuss and assess the application of various immunological indicators as biomarkers for OIT.
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Affiliation(s)
- Haitao Zhu
- Department of Pediatrics (No. 3 Ward), Northwest Women's and Children's Hospital, Xi'an 710061, China
| | - Kaifa Tang
- Department of Urology, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Guoqiang Chen
- Department of Pediatrics (No. 3 Ward), Northwest Women's and Children's Hospital, Xi'an 710061, China
| | - Zhongwei Liu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China.
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8
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Quoc QL, Bich TCT, Jang JH, Park HS. Recent update on the management of anaphylaxis. Clin Exp Emerg Med 2021; 8:160-172. [PMID: 34649404 PMCID: PMC8517462 DOI: 10.15441/ceem.21.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.
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Affiliation(s)
- Quang Luu Quoc
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Tra Cao Thi Bich
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
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9
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Hamed A, Todd I, Tighe PJ, Powell RJ, Harrison T, Fairclough LC. Array-based measurements of aero-allergen-specific IgE correlate with skin-prick test reactivity in asthma regardless of specific IgG4 or total IgE measurements. J Immunol Methods 2021; 492:112999. [PMID: 33609533 DOI: 10.1016/j.jim.2021.112999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/28/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
Skin prick testing (SPT) and measurement of serum allergen-specific IgE (sIgE) are used to investigate asthma and other allergic conditions. Measurement of serum total IgE (tIgE) and allergen-specific IgG4 (sIgG4) may also be useful. The aim was to ascertain the correlation between these serological parameters and SPT. Sera from 60 suspected asthmatic patients and 18 healthy controls were assayed for sIgE and sIgG4 reactivity against a panel of 70 SPT allergen preparations, and for tIgE. The patients were also assessed by skin prick tests for reactivity to cat, dog, house dust mite and grass allergens. Over 50% of the patients had tIgE levels above the 75th percentile of the controls. 58% of patients and 39% of controls showed sIgE reactivity to ≥1 allergen. The mean number of allergens detected by sIgE was 3.1 in suspected asthma patients and 0.9 in controls. 58% of patients and 50% of controls showed sIgG4 reactivity to ≥1 allergen. The mean number of allergens detected by sIgG4 was 2.5 in patients and 1.7 in controls. For the patients, a strong correlation was observed between clinical SPT reactivity and serum sIgE levels to cat, dog, house dust mite (HDM) and grass allergens. SPT correlations using sIgE/sIgG4 or sIgE/tIgE ratios were not markedly higher. The measurement of serum sIgE by microarray using SPT allergen preparations showed good correlation with clinical SPT reactivity to cat, dog, HDM and grass allergens. This concordance was not improved by measuring tIgE or sIgG4.
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Affiliation(s)
- Aljali Hamed
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK; Department of Laboratory Medicine, Faculty of Medical Technology, Omar Al-Mukhtar University, Al Bayda City, Libya
| | - Ian Todd
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK
| | - Patrick J Tighe
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK
| | - Richard J Powell
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK
| | - Tim Harrison
- School of Medicine, Division of Respiratory Medicine, Clinical Sciences Building, City Hospital Campus, University of Nottingham, Nottingham NG5 1PB, UK
| | - Lucy C Fairclough
- School of Life Sciences, The University of Nottingham, Nottingham NG7 2UH, UK.
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10
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Nagakura KI, Sato S, Miura Y, Nishino M, Takahashi K, Asaumi T, Ogura K, Ebisawa M, Yanagida N. A randomized trial of oral immunotherapy for pediatric cow's milk-induced anaphylaxis: Heated vs unheated milk. Pediatr Allergy Immunol 2021; 32:161-169. [PMID: 32869399 PMCID: PMC7821001 DOI: 10.1111/pai.13352] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/25/2020] [Accepted: 08/14/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Severe reactions may develop during cow's milk (CM) oral immunotherapy (OIT). We investigated the safety and efficacy of low-dose OIT with heated milk (HM) or unheated milk (UM) in children with anaphylaxis. METHODS Children with symptom onset after ingestion of 3-mL HM on a double-blind, placebo-controlled food challenge were randomly assigned to the HM (n = 17) or UM (n = 16) group. HM group ingested milk powder heated at 125°C for 30 seconds, whereas the UM group used UM. Patients were hospitalized for 5 days; the HM or UM was gradually increased to 3 mL/day; 3-mL/day ingestion was continued at home. One year later, the patients underwent 2-day consecutive 3- and 25-mL HM-oral food challenges (OFCs) after 2-week avoidance. RESULTS At baseline, milk- and casein-specific immunoglobulin E (IgE) levels were 56.0 and 51.4 kUA/L in the HM group, and 55.2 and 65.6 kUA/L in the UM group, respectively. One year later, 35% and 18% in the HM group and 50% and 31% in UM group passed the 3 and 25 mL OFCs, respectively. Rates of moderate or severe symptoms and respiratory symptoms per home dose were significantly lower in the HM than in the UM group (0.7% and 1.2% vs 1.4% and 2.6%, respectively, P < .001). β-lactoglobulin-specific IgG4 levels significantly increased from baseline only in the UM group, whereas casein-specific IgG4 levels significantly increased from baseline in both groups. CONCLUSIONS HM-OIT induced immunological changes more safely than the UM-OIT. The possibility of lower treatment efficacy with HM-OIT needs to be evaluated in larger studies.
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Affiliation(s)
- Ken-Ichi Nagakura
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.,Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Sakura Sato
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.,Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoko Miura
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Makoto Nishino
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.,Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kyohei Takahashi
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.,Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoyuki Asaumi
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Kiyotake Ogura
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.,Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Motohiro Ebisawa
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.,Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
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11
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Wróblewska B, Kaliszewska-Suchodoła A, Fuc E, Markiewicz LH, Ogrodowczyk AM, Złotkowska D, Wasilewska E. Effect of Low-Immunogenic Yogurt Drinks and Probiotic Bacteria on Immunoreactivity of Cow's Milk Proteins and Tolerance Induction-In Vitro and In Vivo Studies. Nutrients 2020; 12:E3390. [PMID: 33158132 PMCID: PMC7694189 DOI: 10.3390/nu12113390] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
There is no effective therapy for milk allergy. The role of lactic acid bacteria (LAB) and probiotics in protection against allergy-related outcomes is still under investigation. The aim of the study was to evaluate the immunomodulative and therapeutic potential of yogurt drinks in cow's milk allergy (CMA) management. We compared immunoreactivity of α-casein (α-CN), β-casein (β-CN), κ-casein (κ-CN), α-lactalbumin (α-LA), and β-lactoglobulin (β-LG) in 27 yogurt drinks fermented with different basic yogurt cultures, or yogurt cultures enriched with Lactobacillus plantarum and/or Bifidobacterium lactis strains, by competitive ELISA assay. Drinks with the lowest antigenic potential were used as allergoids for CMA therapy. BALB/c mice were sensitized via intraperitoneal injection of α-CN + β-LG mixture with aluminum adjuvant, and gavaged with increasing doses of selected low-immunogenic drinks (YM-basic, or YM-LB-enriched with L. plantarum and B. lactis) to induce tolerance. Milk- or phosphate-buffered saline (PBS)-dosed mice served as controls. Compared to milk, the immunoreactivity of proteins in drinks increased or decreased, depending on the bacterial sets applied for fermentation. Only a few sets acted synergistically in reducing immunoreactivity. The selected low-immunogenic drinks stimulated allergic mice for profiling Th2 to Th1 response and acquire tolerance, and the effect was greater with YM-LB drink, which during long-lasting interventional feeding strongly increased the secretion of regulatory cytokines, i.e., IL-10 and TGF-β, and IgA and decreased IL-4, IgE, and anti-(α-CN + β-LG) IgG1. The studies revealed variations in the potency of yogurt bacteria to change allergenicity of milk proteins and the need for their strict selection to obtain a safe product for allergy sufferers. The YM-LB drink with reduced antigenic potential may be a source of allergoids used in the immunotherapy of IgE mediated CMA, but further clinical or volunteer studies are required.
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Affiliation(s)
- Barbara Wróblewska
- Department of Immunology and Food Microbiology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland; (B.W.); (E.F.); (L.H.M.); (A.M.O.); (D.Z.)
| | | | - Ewa Fuc
- Department of Immunology and Food Microbiology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland; (B.W.); (E.F.); (L.H.M.); (A.M.O.); (D.Z.)
| | - Lidia Hanna Markiewicz
- Department of Immunology and Food Microbiology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland; (B.W.); (E.F.); (L.H.M.); (A.M.O.); (D.Z.)
| | - Anna Maria Ogrodowczyk
- Department of Immunology and Food Microbiology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland; (B.W.); (E.F.); (L.H.M.); (A.M.O.); (D.Z.)
| | - Dagmara Złotkowska
- Department of Immunology and Food Microbiology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland; (B.W.); (E.F.); (L.H.M.); (A.M.O.); (D.Z.)
| | - Ewa Wasilewska
- Department of Immunology and Food Microbiology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Tuwima 10 Str., 10-748 Olsztyn, Poland; (B.W.); (E.F.); (L.H.M.); (A.M.O.); (D.Z.)
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12
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Schoos AMM, Bullens D, Chawes BL, Costa J, De Vlieger L, DunnGalvin A, Epstein MM, Garssen J, Hilger C, Knipping K, Kuehn A, Mijakoski D, Munblit D, Nekliudov NA, Ozdemir C, Patient K, Peroni D, Stoleski S, Stylianou E, Tukalj M, Verhoeckx K, Zidarn M, van de Veen W. Immunological Outcomes of Allergen-Specific Immunotherapy in Food Allergy. Front Immunol 2020; 11:568598. [PMID: 33224138 PMCID: PMC7670865 DOI: 10.3389/fimmu.2020.568598] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022] Open
Abstract
IgE-mediated food allergies are caused by adverse immunologic responses to food proteins. Allergic reactions may present locally in different tissues such as skin, gastrointestinal and respiratory tract and may result is systemic life-threatening reactions. During the last decades, the prevalence of food allergies has significantly increased throughout the world, and considerable efforts have been made to develop curative therapies. Food allergen immunotherapy is a promising therapeutic approach for food allergies that is based on the administration of increasing doses of culprit food extracts, or purified, and sometime modified food allergens. Different routes of administration for food allergen immunotherapy including oral, sublingual, epicutaneous and subcutaneous regimens are being evaluated. Although a wealth of data from clinical food allergen immunotherapy trials has been obtained, a lack of consistency in assessed clinical and immunological outcome measures presents a major hurdle for evaluating these new treatments. Coordinated efforts are needed to establish standardized outcome measures to be applied in food allergy immunotherapy studies, allowing for better harmonization of data and setting the standards for the future research. Several immunological parameters have been measured in food allergen immunotherapy, including allergen-specific immunoglobulin levels, basophil activation, cytokines, and other soluble biomarkers, T cell and B cell responses and skin prick tests. In this review we discuss different immunological parameters and assess their applicability as potential outcome measures for food allergen immunotherapy that may be included in such a standardized set of outcome measures.
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Affiliation(s)
- Ann-Marie Malby Schoos
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Slagelse Sygehus, Slagelse, Denmark
| | - Dominique Bullens
- Allergy and Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Clinical Division of Pediatrics, UZ Leuven, Leuven, Belgium
| | - Bo Lund Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Joana Costa
- REQUIMTE-LAQV, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Liselot De Vlieger
- Allergy and Immunology Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Audrey DunnGalvin
- School of Applied Psychology, University College Cork, Cork, Ireland
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Michelle M. Epstein
- Experimental Allergy Laboratory, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
- Centre of Excellence Immunology, Danone Nutricia research, Utrecht, Netherlands
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Karen Knipping
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
- Centre of Excellence Immunology, Danone Nutricia research, Utrecht, Netherlands
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Dragan Mijakoski
- Institute of Occupational Health of RNM, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, Skopje, North Macedonia
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Inflammation, Repair and Development Section, NHLI, Imperial College London, London, United Kingdom
| | - Nikita A. Nekliudov
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Cevdet Ozdemir
- Institute of Child Health, Department of Pediatric Basic Sciences, Istanbul University, Istanbul, Turkey
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Karine Patient
- SPI—Food Allergy Unit, Département Médicaments et Technologies pour la Santé (DMTS), Université Paris Saclay, CEA, INRAE, Gif-sur-Yvette, France
| | - Diego Peroni
- Section of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sasho Stoleski
- Institute of Occupational Health of RNM, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius, University in Skopje, Skopje, North Macedonia
| | - Eva Stylianou
- Regional Unit for Asthma, Allergy and Hypersensitivity, Department of Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Mirjana Tukalj
- Children’s Hospital, Department of Allergology and Pulmonology, Zagreb, Croatia
- Faculty of Medicine, University of Osijek, Osijek, Croatia
- Catholic University of Croatia, Zagreb, Croatia
| | - Kitty Verhoeckx
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mihaela Zidarn
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
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Three Candidate Probiotic Strains Impact Gut Microbiota and Induce Anergy in Mice with Cow's Milk Allergy. Appl Environ Microbiol 2020; 86:AEM.01203-20. [PMID: 32826221 PMCID: PMC7580549 DOI: 10.1128/aem.01203-20] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022] Open
Abstract
We showed previously that three probiotic strains, i.e., Lactobacillus rhamnosus LA305, L. salivarius LA307, and Bifidobacterium longum subsp. infantis LA308, exerted different preventive effects in a mouse model of cow’s milk allergy. In this study, we evaluated their potential benefits in a curative mouse model of cow’s milk allergy. When administered for 3 weeks after the sensitization process and a first allergic reaction, none of the strains modified the levels of sensitization and allergic markers. However, all three strains affected gut bacterium communities and modified immune and inflammatory responses, leading to a tolerogenic profile. Interestingly, all three strains exerted a direct effect on dendritic cells, which are known to play a major role in food sensitization through their potentially tolerogenic properties and anergic responses. Taken together, these data indicate a potentially beneficial role of the probiotic strains tested in this model of cow’s milk allergy with regard to tolerance acquisition. Cow’s milk allergy is a worldwide public health issue, especially since there is no effective treatment, apart from milk and dairy product avoidance. The aim of this study was to assess the beneficial role of three probiotic strains previously selected for their prophylactic properties in a mouse model of β-lactoglobulin allergy. Administration of Lactobacillus rhamnosus LA305, L. salivarius LA307, or Bifidobacterium longum subsp. infantis LA308 for 3 weeks post–sensitization and challenge modified the composition of the gut microbiota, with an increase in the Prevotella NK3B31 group and a decrease in Marvinbryantia, belonging to the Lachnospiraceae family. Although no impact on markers of sensitization was detected, modifications of foxp3, tgfβ, and il10 ileal gene expression, as well as plasma metabolomic alterations in the tryptophan pathway, were observed. Moreover, ex vivo studies showed that all probiotic strains induced significant decreases in cytokine production by β-lactoglobulin-stimulated splenocytes. Taken together, these results suggest that the three probiotic strains tested lead to alterations in immune responses, i.e., induction of a tolerogenic anergy and anti-inflammatory responses. This anergy could be linked to cecal microbiota modifications, although no impact on fecal short-chain fatty acid (SCFA) concentrations was detected. Anergy could also be linked to a direct impact of probiotic strains on dendritic cells, since costimulatory molecule expression was decreased following coincubation of these strains with bone marrow-derived dendritic cells (BMDCs). To conclude, all three candidate probiotic strains induced strain-specific gut microbiota and metabolic changes, which could potentially be beneficial for general health, as well as anergy, which could contribute to oral tolerance acquisition. IMPORTANCE We showed previously that three probiotic strains, i.e., Lactobacillus rhamnosus LA305, L. salivarius LA307, and Bifidobacterium longum subsp. infantis LA308, exerted different preventive effects in a mouse model of cow’s milk allergy. In this study, we evaluated their potential benefits in a curative mouse model of cow’s milk allergy. When administered for 3 weeks after the sensitization process and a first allergic reaction, none of the strains modified the levels of sensitization and allergic markers. However, all three strains affected gut bacterium communities and modified immune and inflammatory responses, leading to a tolerogenic profile. Interestingly, all three strains exerted a direct effect on dendritic cells, which are known to play a major role in food sensitization through their potentially tolerogenic properties and anergic responses. Taken together, these data indicate a potentially beneficial role of the probiotic strains tested in this model of cow’s milk allergy with regard to tolerance acquisition.
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Huang M, Li X, Tong P, Gao J, Yuan J, Yang A, Chen H, Wu Y. Potential allergenicity assessment after bovine apo-α-lactalbumin binding to calcium ion. J Food Biochem 2020; 44:e13340. [PMID: 32667722 DOI: 10.1111/jfbc.13340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
Bovine α-lactalbumin (α-LA) is recognized as a major milk allergen. Generally, α-LA in the natural state combines with a calcium ion, however, some studies have shown that calcium ions can binding the other metal binding sites in α-LA as well. In our study, the optimal condition of calcium ion binding to α-LA and the change of structure and allergenicity were explored. By optimizing the conditions, the maximum calcium binding amounts of apo-α-LA were obtained in a ratio of 1:4. The structure of α-LA after removal of calcium obviously changed by the spectroscopic detection. For the digestive stability, there was no obvious change in three forms of α-LA. While the allergenic properties were characterized by IgG/IgE inhibition ELISA and the human basophil KU812 degranulation assay. The results showed that IgG and IgE binding decreased, and the degranulation capacity of basophils weakened. Based on these results, calcium binding to apo-α-LA can reduce the potential allergenic properties. PRACTICAL APPLICATIONS: By optimizing the conditions, bovine apo-α-LA can obtain the most calcium binding amount. And calcium binding to apo-α-LA can reduce the potential allergenic properties. Compared with α-LA in the natural state, calcium binding to α-LA not only can reduce the allergenic properties, but also play a role in calcium supplementation. It might be used to guide the development of hypoallergenic α-LA and provide a method to reduce the potential allergenic properties of α-LA.
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Affiliation(s)
- Meijia Huang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,School of Food Science and Technology, NanchangUniversity, Nanchang, China
| | - Xin Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,School of Food Science and Technology, NanchangUniversity, Nanchang, China
| | - Ping Tong
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,School of Food Science and Technology, NanchangUniversity, Nanchang, China
| | - Jinyan Gao
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,School of Food Science and Technology, NanchangUniversity, Nanchang, China
| | - Juanli Yuan
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,School of Pharmacy, Nanchang University, Nanchang, China
| | - Anshu Yang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,Sino-German Joint Research Institute (Jiangxi-OAI), Nanchang University, Nanchang, China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,Sino-German Joint Research Institute (Jiangxi-OAI), Nanchang University, Nanchang, China
| | - Yong Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China.,Sino-German Joint Research Institute (Jiangxi-OAI), Nanchang University, Nanchang, China
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15
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Gruzelle V, Juchet A, Martin-Blondel A, Michelet M, Chabbert-Broue A, Didier A. Benefits of baked milk oral immunotherapy in French children with cow's milk allergy. Pediatr Allergy Immunol 2020; 31:364-370. [PMID: 31943363 DOI: 10.1111/pai.13216] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 12/19/2019] [Accepted: 12/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Introduction and gradual incremental escalation of a low dose of baked milk may accelerate the resolution of severe cow's milk (CM) allergy for some children. The purpose of our study was to evaluate the efficacy and safety of baked milk oral immunotherapy (OIT) in children with CM allergy after a low-dose baked milk oral food challenge (OFC). METHODS In a retrospective analysis of OFC performed between 2013 and 2018 at the Children's Hospital of Toulouse (France), we identified 64 children with CM allergy and high milk and casein-specific IgE levels, who underwent a total of 171 milk OFC. Mean age at 1st OFC was 4.8 years. Mean CM-specific IgE was 47.9 kUA/L, and mean casein-specific IgE was 42.3 kUA/L. RESULTS Most children were treated with baked milk OIT. Our study shows that 67.2% of the children did not react to 1st low-dose baked milk OFC (168.6 mg of CM protein). Eighteen percent of children stopped the OIT at home. Finally, desensitization to fresh milk was achieved in 27 children (42.2% of children allergic to CM). Children with lower CM-specific IgE levels have a significantly higher probability of becoming desensitized to unbaked CM. CONCLUSION Most children with CM allergy and high milk and casein-specific IgE levels tolerate the introduction of baked milk. However, the occurrence of anaphylactic reactions during OIT remains possible.
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Affiliation(s)
- Vianney Gruzelle
- Pediatric Pneumo-allergology Department, Children's Hospital, University Hospital Centre of Toulouse, Toulouse, France
| | - Agnès Juchet
- Pediatric Pneumo-allergology Department, Children's Hospital, University Hospital Centre of Toulouse, Toulouse, France
| | - Audrey Martin-Blondel
- Pediatric Pneumo-allergology Department, Children's Hospital, University Hospital Centre of Toulouse, Toulouse, France
| | - Marine Michelet
- Pediatric Pneumo-allergology Department, Children's Hospital, University Hospital Centre of Toulouse, Toulouse, France
| | - Anne Chabbert-Broue
- Pediatric Pneumo-allergology Department, Children's Hospital, University Hospital Centre of Toulouse, Toulouse, France
| | - Alain Didier
- Department of Respiratory Medicine and Allergic Diseases, University Hospital Centre of Toulouse, Toulouse, France
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Matsui T, Naito M, Tagami K, Tajima I, Teshigawara M, Makino A, Kitamura K, Takasato Y, Sugiura S, Yamada C, Izumi H, Tsuge I, Kondo Y, Ito K. Changes in passively-sensitized basophil activation to αS1-casein after oral immunotherapy. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:188-197. [PMID: 32125071 PMCID: PMC7212200 DOI: 10.1002/iid3.294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Immune response to cow's milk allergen (CMA) has been analyzed mostly using crude milk antigen or a mixture of various caseins. This study aimed to assess the changes in the immunological response against αS1-casein during oral immunotherapy (OIT) and to investigate the mechanism of tolerance. METHODS We have performed rush OIT to 39 patients with CMA and obtained the serum samples up to 3 years after OIT. Immunoglobulin E (IgE) and IgG4 antibodies specific to highly purified αS1-casein as well as passively-sensitized basophil activation were evaluated using the serial samples. Furthermore, we examined whether basophil activation led by the pre-OIT serum was suppressed by the post-OIT serum, or by the tolerant serum obtained from naturally outgrown patients. RESULTS Specific IgE to αS1-casein was significantly reduced after OIT. Specific IgG4 (sIgG4) to αS1-casein was also detected in most of the pre-OIT sera, which was not significantly increased after OIT. Activation of passively-sensitized basophils to αS1-casein was significantly reduced after 2 years (14% ± 19%) and 3 years (19% ± 18%) post-OIT compared with pre-OIT (%CD63high basophils; 51% ± 27%). Furthermore, the addition of post-OIT or tolerant serum to pre-OIT serum significantly suppressed the basophil activation. This suppression was abrogated by washing the supernatant after passive sensitization, but not by depleting IgG antibodies from post-OIT or tolerant sera, nor by blocking FcγRIIb using an anti-FcγR antibody. CONCLUSIONS αS1-casein-sIgG4 plays a minor role in tolerance mechanisms in cases of CMA; humoral factors other than antigen-sIgG4 may be involved.
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Affiliation(s)
- Teruaki Matsui
- Department of Allergy, Aichi Children's Health and Medical Center
| | - Michihiro Naito
- Department of Nutritional Sciences, Nagoya University of Arts and Sciences
| | - Kazunori Tagami
- Department of Allergy, Aichi Children's Health and Medical Center.,Department of Nutritional Sciences, Kasugai Municipal Hospital
| | - Iwao Tajima
- Department of Allergy, Aichi Children's Health and Medical Center.,Department of Pediatrics, Toyohashi Municipal Hospital
| | | | - Atsushi Makino
- Department of Allergy, Aichi Children's Health and Medical Center
| | | | | | - Shiro Sugiura
- Department of Allergy, Aichi Children's Health and Medical Center
| | - Chikako Yamada
- Department of Nutritional Sciences, Nagoya University of Arts and Sciences
| | - Hidehiko Izumi
- Department of Nutritional Sciences, Nagoya University of Arts and Sciences
| | - Ikuya Tsuge
- Department of Pediatrics, Fujita Health University
| | - Yasuto Kondo
- Department of Pediatrics, Fujita Health University
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center
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Kim BG, Kim JN, Jang AS, Shin M. Combined Effects of Lactobacillus rhamnosus and Egg Oral Immunotherapy in a Mouse Model of Egg Allergy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:701-711. [PMID: 32400134 PMCID: PMC7225004 DOI: 10.4168/aair.2020.12.4.701] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/17/2020] [Accepted: 02/04/2020] [Indexed: 01/22/2023]
Abstract
Purpose Recent clinical trials have successfully used oral immunotherapy (OIT) to treat food allergies. Probiotics have immunomodulatory effects by balancing Th1/Th2 immunity and enhancing regulatory T-cell activity. In this study, we analyzed the effects of OIT, probiotics alone, and probiotics administered simultaneously with OIT in a mouse model of egg allergy. Methods C3H/HeJ mice were sensitized by intragastric administration of ovomucoid (OM) with cholera toxin. For the OIT regime, increasing doses of OM were administered orally to sensitized mice. Lactobacillus casei variety ramnosus (Lcr35) was also administered. The mice were divided into 4 groups: control (no OIT), OIT, Lcr35, and OIT plus Lcr35 (OIT + Lcr35). The effects of OIT and Lcr35 treatment were estimated based on the symptom score, rectal temperature, serum levels of OM-specific immunoglobulin (Ig)E, IgA, IgG1, and IgG2a immediately after and 2 weeks after ceasing treatment and histological staining of the small intestine. Results The severity of anaphylaxis decreased in all treatment groups. Simultaneous administration of Lcr35 and OIT decreased the severity of anaphylaxis compared to controls and the OIT group. The protective effects were sustained 2 weeks after ceasing treatment in all treatment groups. A significant decrease in OM-specific IgA, IgG1, and IgG2a levels was observed in both the OIT and OIT plus Lcr35 groups. However, a significant decrease in the OM-specific IgE level was observed only in OIT plus Lcr35 treated mice and was sustained 2 weeks after ceasing treatment. Mucin amounts in the small intestine decreased after OIT, OIT plus Lcr35, and Lcr35 treatment with the lowest in the OIT plus Lcr35 group. Conclusions Lcr35 treatment during OIT had some synergic effect for protection against anaphylaxis in a mice model of egg allergy. These findings should be confirmed in future animal studies including more detailed immunological profiles and human studies.
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Affiliation(s)
- Byeong Gon Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Ji Na Kim
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - An Soo Jang
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea.
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Tian X, Deng Z, Wang S, Wang Y. Basic Research and Clinical Reports Associated with Low Serum IgG4 Concentrations. Int Arch Allergy Immunol 2019; 181:149-158. [PMID: 31805576 DOI: 10.1159/000503967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022] Open
Abstract
Elevated IgG4 concentrations in serum have received a great deal of attention recently, whereas the significance of decreased IgG4 levels was frequently neglected in spite of its close relation with infectious and noninfectious inflammations. In this review, based on the structural and functional characteristics of IgG4, we bring together case reports and research related to low levels of IgG4 and try to scratch the importance of decreased IgG4 concentrations in serum. As with elevated IgG4 levels, low serum IgG4-related diseases can be involved in multiple systems such as infection in the respiratory system, stroke in the circulatory system, and glomerulonephritis in the urinary system. Both genetic and immune dysregulation can contribute to decreased IgG4 levels. In the light of animal experiments, we believe that the mystery of low IgG4 can be revealed as long as enough attention is acquired.
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Affiliation(s)
- Xinyu Tian
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Zhenling Deng
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Song Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Yue Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China,
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Abstract
Respiratory allergy including bronchial asthma and food allergy have gained epidemic character in the last decades in industrialized countries. Much has been learned with respect to the pathophysiology of allergic disease and this has facilitated specific therapies. Allergy is a chronic disease, and being so prevalent claims to search for evolutionary causes of the general susceptibility of humans as a species to react to environmental antigens in a Th2 type immune reaction with IgE production. In an evolutionary analysis of Allergy, necessary questions addressed in this review are "Why does IgE exist or why did IgE evolve?" as well as from the point of view of the mismatch hypothesis, "Why is there an Allergy epidemic?" Recent studies on the possible biological and protective role of IgE against parasites, arthropods, venoms or toxins are challenging the widely accepted definition of allergens as generally innocuous antigens. Combining the immunologic danger model and the toxin hypothesis for allergies, the allergic response could have evolved with an adaptive value and allergens could be proxies for other putative noxious agents. The last decades yielded with vast molecular data of allergens. With available bioinformatics tools, we therefore also describe that evolutionary theory could be applied to prevent allergy, estimate cross-reactivity, to design allergen-specific immunotherapy and to assess the risks of novel foods.
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Alves-Correia M, Gaspar Â, Borrego LM, Azevedo J, Martins C, Morais-Almeida M. Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up. Allergol Immunopathol (Madr) 2019; 47:133-140. [PMID: 30482599 DOI: 10.1016/j.aller.2018.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary. OBJECTIVE We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA. MATERIALS AND METHODS The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells). RESULTS The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127-/dim regulatory T cells were increased after OIT. CONCLUSIONS OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.
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Abstract
Oral tolerance is a state of systemic unresponsiveness that is the default response to food antigens in the gastrointestinal tract, although immune tolerance can also be induced by other routes, such as the skin or inhalation. Antigen can be acquired directly by intestinal phagocytes, or pass through enterocytes or goblet cell-associated passages prior to capture by dendritic cells (DCs) in the lamina propria. Mucin from goblet cells acts on DCs to render them more tolerogenic. A subset of regulatory DCs expressing CD103 is responsible for delivery of antigen to the draining lymph node and induction of Tregs. These DCs also imprint gastrointestinal homing capacity, allowing the recently primed Tregs to home back to the lamina propria where they interact with macrophages that produce IL-10 and expand. Tregs induced by dietary antigen include Foxp3+ Tregs and Foxp3- Tregs. In addition to Tregs, T cell anergy can also contribute to oral tolerance. The microbiota plays a key role in the development of oral tolerance, through regulation of macrophages and innate lymphoid cells that contribute to the regulatory phenotype of gastrointestinal dendritic cells. Absence of microbiota is associated with a susceptibility to food allergy, while presence of Clostridia strains can suppress development of food allergy through enhancement of Tregs and intestinal barrier function. It is not clear if feeding of antigens can also induce true immune tolerance after a memory immune response has been generated, but mechanistic studies of oral immunotherapy trials demonstrate shared pathways in oral tolerance and oral immunotherapy, with a role for Tregs and anergy. An important role for IgA and IgG antibodies in development of immune tolerance is also supported by studies of oral tolerance in humans. The elucidation of key pathways in oral tolerance could identify new strategies to increase efficacy of immunotherapy treatments for food allergy.
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Affiliation(s)
- Leticia Tordesillas
- Jaffe Food Allergy Institute, Immunology Institute, Mindich Child Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Cecilia Berin
- Jaffe Food Allergy Institute, Immunology Institute, Mindich Child Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Box 1198, One Gustave L. Levy Place, New York, NY, 10029, USA.
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Huang J, Liu C, Wang Y, Wang C, Xie M, Qian Y, Fu L. Application of in vitro and in vivo models in the study of food allergy. FOOD SCIENCE AND HUMAN WELLNESS 2018. [DOI: 10.1016/j.fshw.2018.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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23
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Bernaldo de Quiros E, Seoane-Reula E, Alonso-Lebrero E, Pion M, Correa-Rocha R. The role of regulatory T cells in the acquisition of tolerance to food allergens in children. Allergol Immunopathol (Madr) 2018; 46:612-618. [PMID: 29739687 DOI: 10.1016/j.aller.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/31/2018] [Accepted: 02/09/2018] [Indexed: 01/03/2023]
Abstract
Food allergy is a pathological immune reaction that identifies certain harmless food proteins, usually tolerated by the majority of the people, as a threat. The prevalence of these food allergies is increasing worldwide and currently affects 8% of children. Exacerbated reactions to milk, egg and peanut are the most frequent in the pediatric population. It is well known that allergic diseases are a type 2 T-helper (Th2) immune response, characterized by the elevated production of IgE antibodies. However, little is known about the immune mechanisms responsible for the development of clinical tolerance toward food allergens. Recent studies have suggested the key role of regulatory T cells (Tregs) in controlling allergic inflammation. In this review, we discuss the importance of Tregs in the pathogenesis of food allergy and the acquisition of oral tolerance in children. Further investigation in this area will be crucial for the identification of predictive markers and the development of new therapies, which will represent a clinical and social benefit for these allergic diseases.
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Vultaggio A, Nencini F, Carraresi A, Pratesi S, Movérare R, Eriksson C, Venemalm L, Maggi E, Matucci A. IgG4 anti-infliximab in treated patients: Clinical impact and temporal evolution. Allergy 2018; 73:2172-2181. [PMID: 29719053 DOI: 10.1111/all.13471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Infliximab (IFX) carries potential risk of immunogenicity with the production of anti-drug antibodies (ADA). ADA may belong to different isotypes and are usually measured by ELISA bridging assay. This test is not designed to detect IgG4 antibodies. The aim was to measure IgG4 anti-IFX antibodies in a cohort of IFX-treated patients and to evaluate their relationship with ADA and their clinical impact. METHODS Anti-drug antibodies were detected using a bridging ELISA in the serum of 222 treated patients with different clinical outcomes to IFX. The same samples were analyzed for IgG4 anti-IFX antibodies using an experimental ImmunoCAP assay with reduced serum IgG4 background levels. A longitudinal evaluation was performed in a subgroup of 38 patients to define the temporal evolution of IgG4 anti-IFX. RESULTS IgG4 anti-IFX was found in 26.6% of patients. Eighty of 222 patients were ADA+ (36%) and the majority (57/80, 71.3%) had IgG4 anti-IFX. Two IgG4-positive but ADA-negative patients were identified. IgG4 anti-IFX levels correlated with the serum levels of ADA. IgG4 anti-IFX was more common in both reactive and nonresponder patients than in tolerant/responder patients. Patients who had experienced IgE-mediated reactions displayed significantly higher IgG4 anti-IFX than IgE-negative reactive patients. The majority of patients tested positive for IgG4 anti-IFX after the first seven infusions. CONCLUSIONS IgG4 anti-IFX is common in treated patients and a large part of ADA producing patients produce IgG4 antibodies. The IgG4 anti-IFX response does not prevent hypersensitivity reactions to IFX and correlates with the IgE anti-IFX response.
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Affiliation(s)
- A. Vultaggio
- Immunoallergology Unit Department of Biomedicine; Careggi University Hospital; Florence Italy
| | - F. Nencini
- Centre for Research Transfer and High Education DENOTHE and Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - A. Carraresi
- Immunoallergology Unit Department of Biomedicine; Careggi University Hospital; Florence Italy
| | - S. Pratesi
- Centre for Research Transfer and High Education DENOTHE and Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - R. Movérare
- Thermo Fisher Scientific ImmunoDiagnostics; Uppsala Sweden
- Department of Medical Sciences Respiratory, Allergy and Sleep Research; Uppsala University; Uppsala Sweden
| | - C. Eriksson
- Thermo Fisher Scientific ImmunoDiagnostics; Uppsala Sweden
| | - L. Venemalm
- Thermo Fisher Scientific ImmunoDiagnostics; Uppsala Sweden
| | - E. Maggi
- Centre for Research Transfer and High Education DENOTHE and Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - A. Matucci
- Immunoallergology Unit Department of Biomedicine; Careggi University Hospital; Florence Italy
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Inuo C, Tanaka K, Suzuki S, Nakajima Y, Yamawaki K, Tsuge I, Urisu A, Kondo Y. Oral Immunotherapy Using Partially Hydrolyzed Formula for Cow's Milk Protein Allergy: A Randomized, Controlled Trial. Int Arch Allergy Immunol 2018; 177:259-268. [PMID: 30134240 DOI: 10.1159/000490804] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partially hydrolyzed cow's milk protein-based formula (pHF) possesses low allergenicity. Here, we investigate the safety and efficacy of oral immunotherapy using pHF for children with cow's milk protein allergy (CMPA). OBJECTIVES A randomized, double-blind, controlled single-center trial was conducted to evaluate the efficacy and safety of pHF oral immunotherapy in children with CMPA. METHODS Participants were randomized into double-blind pHF-pHF and extensively hydrolyzed cow's milk protein-based formula (eHF)-pHF groups. During this phase, the pHF-pHF group received pHF and the eHF-pHF group received eHF. During the open phase, all participants received pHF. The primary end point was a change in thresholds between baseline and the end of the first phase. Secondary end points were changes in thresholds between baseline and the end of the second phase, and casein-specific immunoglobulin (Ig)E, IgG4, and basophil activation. RESULTS Twenty-five children, aged 1-9 years, were randomized into pHF-pHF and eHF-pHF groups. The threshold between baseline and the end of the first phase was significantly elevated in the pHF-pHF group (p = 0.048), but not in the eHF-pHF group. The threshold between other phases did not change significantly in either group. There were significant decreases in casein-specific IgE antibody levels between baseline and the second phase in the eHF-pHF group (p = 0.014). No participants suffered systemic allergic reactions requiring adrenaline or systemic corticosteroids after receiving the formulas. CONCLUSIONS The results of this trial suggest that, in children with CMPA, tolerance to cow's milk might be safely enhanced by intake of pHF, relative to that of eHF.
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Affiliation(s)
- Chisato Inuo
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan.,Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan.,Department of Allergy, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kenichi Tanaka
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Satoko Suzuki
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Yoichi Nakajima
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kazuo Yamawaki
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Ikuya Tsuge
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Atsuo Urisu
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Yasuto Kondo
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
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26
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Novel immunotherapy and treatment modality for severe food allergies. Curr Opin Allergy Clin Immunol 2018; 17:212-219. [PMID: 28362675 DOI: 10.1097/aci.0000000000000365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In recent years, many studies on oral immunotherapy (OIT) have been conducted; however, few have focused on severe food allergies. The purpose of this review was to assess the efficacy and safety of oral immunotherapies for patients with severe food allergy. RECENT FINDINGS We reviewed multiple immunotherapy reports published within a few years or reports focusing on severe food allergies. We also investigated recent studies on OIT and novel food allergy management. SUMMARY Immunotherapies targeting low-dose antigen exposure and oral food challenges using low-dose target volumes may be safer than conventional OIT. It is necessary to consider which immunotherapy regimen is appropriate based on allergy severity of the patient.
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Feuille E, Nowak-Wegrzyn A. Allergen-Specific Immunotherapies for Food Allergy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:189-206. [PMID: 29676066 PMCID: PMC5911438 DOI: 10.4168/aair.2018.10.3.189] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022]
Abstract
With rising prevalence of food allergy (FA), allergen-specific immunotherapy (AIT) for FA has become an active area of research in recent years. In AIT, incrementally increasing doses of inciting allergen are given with the goal to increase tolerance, initially through desensitization, which relies on regular exposure to allergen. With prolonged therapy in some subjects, AIT may induce sustained unresponsiveness, in which tolerance is retained after a period of allergen avoidance. Methods of AIT currently under study in humans include oral, sublingual, epicutaneous, and subcutaneous delivery of modified allergenic protein, as well as via DNA-based vaccines encoding allergen with lysosomal-associated membrane protein I. The balance of safety and efficacy varies by type of AIT, as well as by targeted allergen. Age, degree of sensitization, and other comorbidities may affect this balance within an individual patient. More recently, AIT with modified proteins or combined with immunomodulatory therapies has shown promise in making AIT safer and/or more effective. Though methods of AIT are neither currently advised by experts (oral immunotherapy [OIT]) nor widely available, AIT is likely to become a part of recommended management of FA in the coming years. Here, we review and compare methods of AIT currently under study in humans to prepare the practitioner for an exciting new phase in the care of food allergic patients in which improved tolerance to inciting foods will be a real possibility.
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Affiliation(s)
- Elizabeth Feuille
- Division of Pediatric Pulmonology, Allergy, and Immunology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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28
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Abstract
The gastrointestinal tract has an abundant mucosal immune system to develop and maintain oral tolerance. The oral route of administration takes advantage of the unique set of immune cells and pathways involved in the induction of oral tolerance. Food allergy results from a loss of oral tolerance toward ingested antigens. Oral immunotherapy is thought to initiate desensitization through interaction of an allergen with mucosal dendritic cells that initiate downstream immune system modulation through regulatory T cells and effector T cells.
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Affiliation(s)
- Erik Wambre
- Benaroya Research Institute at Virginia Mason, 1201 Ninth Avenue, Seattle, WA 98101, USA.
| | - David Jeong
- Virginia Mason Medical Center, 1201 Terry Avenue, Seattle, WA 98101, USA
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