Division of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Department of Immunology, Nutricia Research, Utrecht, The Netherlands.
Pediatr Allergy Immunol. 2013 Nov;24(7):633-44. doi: 10.1111/pai.12122.
Food allergy is a growing health concern in the westernized world with approx. 6% of children suffering from it. A lack of approved treatment has led to strict avoidance of the culprit food proteins being the only standard of care. Nowadays in-depth research is conducted to evaluate the possible use of allergen-specific immunotherapy (SIT) as an active therapeutic option for food allergy. Various routes of administration for the immunotherapy are investigated, including subcutaneous, oral, sublingual, and epicutaneous, and some appear to be successful in inducing a temporary tolerant state. Most research has been conducted with oral immunotherapy due to its efficacious and relatively safe profile. Increasing interest is dedicated to safer and more convenient approaches, such as sublingual and epicutaneous SIT; however, doubts exist about their possible capacity to induce temporary tolerant state and permanent oral tolerance. The high frequency of allergic adverse reactions of the various approaches and the inability to achieve permanent oral tolerance have highlighted the need of refinements in the strategies. A promising strategy for preventing IgE cross-linking and thus enhancing safety of SIT, while still activating T cells, is the use of tolerogenic peptides. The implementation of such an immunotherapy approach has the potential of not only increasing the chance of achieving a permanent state of tolerance, but also improving the safety and tolerability of the therapy. Immunotherapy for food allergy is still not ready for the clinic, but current and upcoming studies are dedicated to collect enough evidence for the possible implementation of allergen-SIT as a standard treatment for food allergy.
食物过敏是西方化世界中日益严重的健康问题，约有 6%的儿童患有食物过敏。由于缺乏经过批准的治疗方法，严格避免食用过敏原蛋白已成为唯一的治疗标准。如今，人们正在深入研究过敏原特异性免疫疗法（SIT）作为食物过敏的一种积极治疗选择的可能性。正在研究各种免疫疗法的给药途径，包括皮下、口服、舌下和经皮，其中一些途径似乎成功地诱导了暂时的耐受状态。由于口服免疫疗法具有疗效好且相对安全的特点，因此大多数研究都是针对口服免疫疗法进行的。人们越来越关注更安全、更方便的方法，如舌下和经皮 SIT；然而，对于它们是否有能力诱导暂时的耐受状态和永久的口服耐受状态存在疑问。各种方法的高频率过敏不良反应和无法实现永久口服耐受状态突出表明需要改进策略。使用耐受原性肽是一种有前途的策略，可以防止 IgE 交联，从而提高 SIT 的安全性，同时仍能激活 T 细胞。实施这种免疫疗法有可能不仅增加实现永久耐受状态的机会，而且还提高治疗的安全性和耐受性。食物过敏的免疫疗法尚未准备好应用于临床，但目前和即将进行的研究旨在收集足够的证据，以便将过敏原 SIT 作为食物过敏的标准治疗方法实施。
