COMMENTARY

Food Allergy: What You Need to Know

Stephanie A. Leonard, MD

Disclosures

November 15, 2010

In This Article

State of the Science: Research in Food Allergy

Subcutaneous immunotherapy (SCIT) has been used successfully for other allergic diseases, such as seasonal allergies, venom allergy, and asthma; however, unacceptable rates of systemic reactions have put SCIT trials for food allergy on hold.[86,87]

Results have been favorable in oral immunotherapy (OIT) clinical trials for food allergy, in which patients have tolerated increased amounts of egg, milk or peanut with fewer and more minor side effects.[88,89,90,91] When OIT was discontinued, however, clinical reactivity returned in a subset of patients, indicating desensitization, and not permanent tolerance, occurred.[88,92]

Food processing alters protein structure and affects allergenicity.[93] For example, heating or incorporating egg or milk into a wheat matrix can reduce allergenicity by destroying or blocking IgE-recognized peptides. Extensively heated protein represents an alternative and possibly safer method to OIT. In 2 recent studies, 70% of egg- and cow's milk-allergic children were able to tolerate extensively heated egg or milk.[14,94] Decreasing skin test wheal size and increasing egg- or milk-specific IgG4 were seen with continued incorporation of extensively heated egg or milk in the diet, findings that are often seen as allergies resolve. Both OIT and introducing extensively heated egg and milk, however, remain investigational and are not currently the standard of care.

Sublingual immunotherapy, oral immunotherapy given in conjunction with omalizumab, recombinant vaccines, and Chinese herbal medicine are other methods that are currently in clinical trials.[95]

Food allergy clinical trials may be viewed at ClinicalTrials.gov. Research in peptide immunotherapy, adjuvant-associated protein immunotherapy, and plasmid DNA immunotherapy are still in the laboratory at this time.[95]

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