a Department of Allergy and Immunology , Centre Hospitalier Universitaire Sainte-Justine , Montreal , QC , Canada.
b Department of Allergy and Immunology , Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame , Montreal , QC , Canada.
Expert Rev Clin Immunol. 2019 May;15(5):449-460. doi: 10.1080/1744666X.2019.1593138. Epub 2019 Mar 27.
Food allergy prevalence has increased in recent decades, which has mobilized efforts to develop treatment alternatives. Epicutaneous immunotherapy (EPIT) is a novel method that involves transdermal administration of peanut allergen with the objective to induce tolerance. Recent clinical trials have shown its efficacy at increasing the eliciting dose in children with a favorable safety profile. Areas covered: This review covers the proposed mechanism of action of EPIT in murine models and humans, efficacy and safety data from clinical trials with peanut EPIT, and a discussion on its potential role in the future management of peanut allergy. Expert opinion: With the recent completion of pivotal trials for peanut EPIT and upcoming marketing, the main question for clinicians and food allergic patients is how to define its role in the management of peanut allergy and how it compares to oral immunotherapy (OIT). Like OIT, EPIT seems to promote immunological tolerance over time. However, EPIT could lack the rapid mast-cell desensitization induced by the progressive intake of food in OIT, which explains differences in short-term outcomes and safety profiles. Head-to-head and long-term comparison of real-life efficacy with regards to sustained unresponsiveness will help define its place in the food allergy arsenal.
食物过敏的患病率在近几十年有所增加，这促使人们努力开发治疗的替代方法。经皮免疫疗法（EPIT）是一种新的方法，通过透皮给予花生过敏原，目的是诱导耐受。最近的临床试验表明，它在增加儿童的过敏原剂量方面具有疗效，且安全性良好。
本文综述了 EPIT 在小鼠模型和人体中的作用机制、花生 EPIT 的临床试验的疗效和安全性数据，并讨论了其在未来花生过敏管理中的潜在作用。
随着花生 EPIT 的关键试验的最近完成和即将上市，临床医生和食物过敏患者的主要问题是如何定义其在花生过敏管理中的作用，以及它与口服免疫疗法（OIT）相比如何。与 OIT 一样，EPIT 似乎随着时间的推移促进免疫耐受。然而，EPIT 可能缺乏 OIT 中逐渐摄入食物引起的快速肥大细胞脱敏，这解释了短期结果和安全性特征的差异。关于无反应的持续时间，进行 EPIT 与 OIT 的真实疗效的头对头和长期比较将有助于确定其在食物过敏武器库中的地位。
