Food Allergy Diagnosis and Therapy

Where Are We Now?

Aleena Syed; Arunima Kohli1; Kari C Nadeau

Disclosures

Immunotherapy. 2013;5(9):931-944. 

In This Article

Conclusion & Future Perspective

FA is a complex, multifactorial disease with increasing prevalence worldwide. Research into the mechanisms and risk factors underlying FA has elucidated some of the features of this disease and have suggested potential avenues for treatment, although much remains unknown. Further understanding of FA mechanisms will likely come from studies of genetics and epigenetic factors, as well as enhanced demographic studies; new guidelines regarding maternal diet will likely be generated on the basis of early exposure studies. Although there has been an increase in the report of FA, diagnostics are currently imprecise, and must be refined in order to determine disease severity and the possibility of developing spontaneous tolerance, as well as to better understand the global impact of FA. We hypothesize that the development of sophisticated, high-resolution tools will aid in the development of diagnostics that are minimally invasive, low risk and individualized to hold the potential to identify and monitor candidates for therapy, conditions that are not met by current practices and tools.

Several potential therapies, both specific and nonspecific, are under investigation; of these, the most researched, and potentially most promising, is OIT. At the same time, researchers agree OIT is not ready for clinical use, given the high rate of associated adverse events and the risk of resensitization. Future studies must examine long-term effects of OIT, and seek to standardize protocols and monitoring. Combining OIT with adjunctive therapies such as anti-IgE, SLIT and modified allergens may potentially increase the safety, efficacy and feasibility of this therapy for FA. Other therapies that will likely become more heavily researched are SLIT, EPIT, intralymphatic immunotherapy, peptide immunotherapy and the use of bacterial adjuvants. At this time, however, OIT – and, indeed, all immunotherapies for FA – are highly experimental, and much more research is needed before any of these can enter the clinic. We cannot overstate the importance of studying both the mechanisms and patient outcomes in the assessment of potential therapies.

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