Department of Allergy and Clinical Immunology, University of Michigan Medical School, University of Michigan Health Systems, Ann Arbor, MI 48106, USA.
Allergy Asthma Proc. 2013 May-Jun;34(3):197-204. doi: 10.2500/aap.2013.34.3661.
Food oral immunotherapy (OIT) is an investigational peanut allergy treatment aimed to achieve specific oral tolerance induction. Allergic children are given titrated oral (or sublingual) doses of their allergen on a daily basis, unlike in subcutaneous immunotherapy (SCIT). OIT is theorized to cause a shift from a Th2 to a Th1 regulatory environment, reflected by increases in food-specific IgG4/IgE, and the production of FoxP3. Peanut OIT holds special promise because peanut allergy has an unfavorable natural history and is rarely outgrown. A high percentage of the participants experience symptoms during peanut OIT, including anaphylaxis, warranting epinephrine and/or discontinuation of therapy. This is a concerning fact given that the studies have mostly targeted only older children, with less historical reactivity for enrollment. The handful of peanut OIT studies have shown that some participants can be desensitized to peanut, but none have shown that long-term tolerance can be reestablished. Factors predictive of which patients are most likely to succeed and become desensitized through OIT are unknown. Some private practices have begun offering peanut OIT as a therapy. Such practice is potentially dangerous given the safety and efficacy of OIT in randomized controlled clinical trials is still not well established. Therefore, until further investigation emerges that conclusively demonstrates OIT is safe, intermediate and long-term outcomes are better established, the number of participants that experience symptoms is reduced, and proof of concept established in patients of all ages, (irrespective of past reaction severity), OIT is not ready for use in the general allergy practice.
食物口服免疫疗法（OIT）是一种正在研究中的治疗花生过敏的方法，旨在实现特定的口服耐受诱导。与皮下免疫疗法（SCIT）不同，过敏儿童每天接受滴定口服（或舌下）剂量的过敏原。OIT 的理论基础是引起从 Th2 到 Th1 调节环境的转变，这反映在食物特异性 IgG4/IgE 的增加和 FoxP3 的产生上。花生 OIT 具有特殊的前景，因为花生过敏具有不利的自然病史，并且很少会自行消退。很大比例的参与者在花生 OIT 期间会出现症状，包括过敏反应，需要肾上腺素和/或停止治疗。鉴于这些研究主要针对年龄较大的儿童，并且入组时的历史反应性较少，这是一个令人担忧的事实。少数花生 OIT 研究表明，一些参与者可以对花生脱敏，但没有研究表明可以重新建立长期耐受。预测哪些患者最有可能通过 OIT 成功脱敏的因素尚不清楚。一些私人诊所已经开始提供花生 OIT 作为一种治疗方法。鉴于 OIT 在随机对照临床试验中的安全性和有效性尚未得到充分确立，这种做法可能存在危险。因此，在进一步的研究得出结论证明 OIT 是安全的、中期和长期结果得到更好的确立、减少出现症状的参与者数量以及在所有年龄段的患者中证明概念的有效性（无论过去的反应严重程度如何）之前，OIT 还不准备在一般过敏实践中使用。
