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      Oral Immunotherapy for Food Allergy: Towards a New Horizon

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          Abstract

          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.

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          Fatalities due to anaphylactic reactions to foods.

          S A Bock, A Muñoz-Furlong, H Sampson (2001)
          Fatal anaphylactic reactions to foods are continuing to occur, and better characterization might lead to better prevention. The objective of this report is to document the ongoing deaths and characterize these fatalities. We analyzed 32 fatal cases reported to a national registry, which was established by the American Academy of Allergy, Asthma, and Immunology, with the assistance of the Food Allergy and Anaphylaxis Network, and for which adequate data could be collected. Data were collected from multiple sources including a structured questionnaire, which was used to determine the cause of death and associated factors. The 32 individuals could be divided into 2 groups. Group 1 had sufficient data to identify peanut as the responsible food in 14 (67%) and tree nuts in 7 (33%) of cases. In group 2 subjects, 6 (55%) of the fatalities were probably due to peanut, 3 (27%) to tree nuts, and the other 2 cases were probably due to milk and fish (1 [9%] each). The sexes were equally affected; most victims were adolescents or young adults, and all but 1 subject were known to have food allergy before the fatal event. In those subjects for whom data were available, all but 1 was known to have asthma, and most of these individuals did not have epinephrine available at the time of their fatal reaction. Fatalities due to ingestion of allergenic foods in susceptible individuals remain a major health problem. In this series, peanuts and tree nuts accounted for more than 90% of the fatalities. Improved education of the profession, allergic individuals, and the public will be necessary to stop these tragedies.
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            Epidemiology of food allergy.

            Scott H. Sicherer (2011)
            Adverse reactions to foods can occur for a variety of reasons, but a food allergy is caused by a specific immune response. Challenges to determine the prevalence of food allergy include misclassification, biased participation, lack of simple diagnostic tests, rapid evolution of disease, large numbers of potential triggers, and varied clinical phenotypes. Nonetheless, it is clear that this is a common disorder, with studies suggesting a cumulative prevalence of 3% to 6%, representing a significant impact on quality of life and costs. The inclusion of mild reactions to fruits and vegetables could result in calculation of prevalence exceeding 10% in some regions. There are data from numerous studies to suggest an increase in prevalence, but methodologic concerns warrant caution. Prevalence varies by age, geographic location, and possibly race/ethnicity. Many childhood food allergies resolve. Population-based epidemiologic studies have generated numerous novel theories regarding risks, including modifiable factors such as components of the maternal and infant diet, obesity, and the timing of food introduction. Recent and ongoing studies provide insights on risk factors, prevalence, and natural course that may inform clinical trials to improve diagnosis, prevention, and treatment. Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
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              Food allergy among children in the United States.

              S. Lukacs, Amy M Branum (2009)
              The goals were to estimate the prevalence of food allergy and to describe trends in food allergy prevalence and health care use among US children. A cross-sectional survey of data on food allergy among children <18 years of age, as reported in the 1997-2007 National Health Interview Survey, 2005-2006 National Health and Nutrition Examination Survey, 1993-2006 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey, and 1998-2006 National Hospital Discharge Survey, was performed. Reported food allergies, serum immunoglobulin E antibody levels for specific foods, ambulatory care visits, and hospitalizations were assessed. In 2007, 3.9% of US children <18 years of age had reported food allergy. The prevalence of reported food allergy increased 18% (z = 3.4; P < .01) from 1997 through 2007. In 2005-2006, serum immunoglobulin E antibodies to peanut were detectable for an estimated 9% of US children. Ambulatory care visits tripled between 1993 and 2006 (P < .01). From 2003 through 2006, an estimated average of 317000 food allergy-related, ambulatory care visits per year (95% confidence interval: 195000-438000 visits per year) to emergency and outpatient departments and physician's offices were reported. Hospitalizations with any recorded diagnoses related to food allergy also increased between 1998-2000 and 2004-2006, from an average of 2600 discharges per year to 9500 discharges per year (z = 3.4; P < .01), possibly because of increased use of food allergy V codes. Several national health surveys indicate that food allergy prevalence and/or awareness has increased among US children in recent years.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Allergy Asthma Immunol Res
                Journal ID (iso-abbrev): Allergy Asthma Immunol Res
                Journal ID (publisher-id): AAIR
                Title: Allergy, Asthma & Immunology Research
                Publisher: The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease
                ISSN (Print): 2092-7355
                ISSN (Electronic): 2092-7363
                Publication date (Print): January 2013
                Publication date (Electronic): 28 November 2012
                Volume: 5
                Issue: 1
                Pages: 3-15
                Affiliations
                Division of Immunology and Allergy, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
                Author notes
                Correspondence to: Dale T. Umetsu, MD, PhD, Division of Immunology and Allergy, Boston Children's Hospital, Harvard Medical School, Boston, MA 02459, USA. Tel: +1-617-919-2439; Fax: +1-617-730-0384; Dale.Umetsu@ 123456childrens.harvard.edu
                Article
                DOI: 10.4168/aair.2013.5.1.3
                PMC ID: 3529226
                PubMed ID: 23277873
                SO-VID: 1bf6757b-fe7b-4c13-940e-582c9c3738f7
                Copyright © Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 05 April 2012
                Date accepted : 11 May 2012
                Categories
                Subject: Review

                ScienceOpen disciplines: Immunology
                Keywords: oral immunotherapy,omalizumab,anti-ige,xolair,food allergy,desensitization
                Data availability:
                ScienceOpen disciplines: Immunology
                Keywords: oral immunotherapy, omalizumab, anti-ige, xolair, food allergy, desensitization

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