Karp Laboratories, Division of Immunology and Allergy, Boston Children's Hospital, Boston, MA 02115, USA.
Semin Immunopathol. 2012 Sep;34(5):689-702. doi: 10.1007/s00281-012-0333-9. Epub 2012 Jul 21.
Food allergy is a major public health concern in westernized countries, estimated to affect 5 % of children and 3-4 % of adults. Allergen-specific immunotherapy for food allergy is currently being actively evaluated, but is still experimental. The optimal protocol, in terms of the route of administration of the food, target maintenance dose, and duration of maintenance therapy, and the optimal patient for these procedures are still being worked out. The mechanisms underlying successful food desensitization are also unclear, in part, because there is no standard immunotherapy protocol. The mechanisms involved, however, may include mast cell and basophil suppression, development of food-specific IgG4 antibodies, reduction in the food-specific IgE/IgG4 ratio, up-regulation and expansion of natural or inducible regulatory T cells, a skewing from a Th2 to a Th1 profile, and the development of anergy and/or deletion in antigen-specific cells. Additional studies are required to elucidate and understand these mechanisms by which desensitization and tolerance are achieved, which may reveal valuable biomarkers for evaluating and following food allergic patients on immunotherapy.
食物过敏是西方国家的一个主要公共卫生问题，估计有 5%的儿童和 3-4%的成年人受到影响。目前正在积极评估针对食物过敏的过敏原特异性免疫疗法，但仍处于试验阶段。在食物给药途径、目标维持剂量和维持治疗持续时间方面，以及最适合这些程序的患者方面，最佳方案仍在制定中。成功脱敏的机制也不清楚，部分原因是没有标准的免疫治疗方案。然而，所涉及的机制可能包括肥大细胞和嗜碱性粒细胞抑制、产生食物特异性 IgG4 抗体、减少食物特异性 IgE/IgG4 比值、上调和扩增天然或诱导性调节性 T 细胞、从 Th2 向 Th1 模式转变，以及产生无反应性和/或抗原特异性细胞缺失。需要进一步研究来阐明和理解脱敏和耐受的这些机制，这可能揭示有价值的生物标志物，用于评估和随访接受免疫治疗的食物过敏患者。
