University of Lyon 1 Claude-Bernard, Villeurbanne, France; Pediatric Pulmonology and Allergology Department, Pediatric Cystic Fibrosis Center, hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
Pediatric Pulmonology and Allergology Department, Pediatric Cystic Fibrosis Center, hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
Arch Pediatr. 2021 May;28(4):319-324. doi: 10.1016/j.arcped.2021.03.006. Epub 2021 Apr 12.
Food oral immunotherapy (OIT) is a promising treatment for persistent and severe food allergies (FAs) in children, but also for accelerating tolerance to cow's milk and cooked egg in young children. In the near future, pediatricians will increasingly encounter severely allergic children undergoing FA-OIT. FA-OIT consists in daily ingestion of increasing doses of the allergen during the up-dosing phase, and ingestion of a constant dose during the maintenance phase. The global aim is to increase the reactive threshold of allergic patients, and finally enable them to ingest a target quantity of allergen without any reaction throughout the treatment (desensitization). Many studies showed the efficacy of FA-OIT in desensitization, and some of them in sustained unresponsiveness. This corresponds to tolerance after FA-OIT discontinuation, especially for cow's milk and hen's egg allergy. However, there is an ongoing debate about the safety of the treatment. Side effects are frequent, notably aversion to the allergen and oral syndromes as well as systemic allergic symptoms. These reactions occur mainly during the up-dosing phase and become less frequent with time, but they are common causes of FA-OIT discontinuation. Patients and their families must be trained to manage these reactions at home. Long-term side effects can also occur, such as eosinophilic esophagitis. Pediatricians play an important role in maintaining patient motivation; they also provide knowledge on possible allergic reactions and the reactogenic cofactors (mainly fever and viral infection, anti-inflammatory intake, physical activity), and refer the patient to the relevant specialists in the case of long-term care. Other routes of administration for food immunotherapy (epicutaneous and sublingual) and different adjuvant treatments (probiotics, anti-IgE molecule) are currently under study. This will allow us to improve the efficacy of immunotherapy and reduce the risk of any side effects, in order to provide a more favorable risk-benefit ratio.
食物口服免疫治疗（OIT）是一种有前途的治疗儿童持续性和严重食物过敏（FA）的方法，也可用于加速幼儿对牛奶和熟鸡蛋的耐受。在不久的将来，儿科医生将越来越多地遇到正在接受 FA-OIT 的严重过敏儿童。FA-OIT 包括在加量阶段每天摄入逐渐增加剂量的过敏原，以及在维持阶段摄入恒定剂量。全球目标是提高过敏患者的反应阈值，最终使他们能够在整个治疗过程中（脱敏）摄入目标量的过敏原而不发生任何反应。许多研究表明 FA-OIT 在脱敏方面的疗效，其中一些研究表明其具有持续的无反应性。这对应于 FA-OIT 停止后的耐受，特别是对牛奶和鸡蛋过敏。然而，关于治疗的安全性仍存在争议。副作用很常见，特别是对过敏原和口腔综合征以及全身性过敏症状的厌恶。这些反应主要发生在加量阶段，随着时间的推移变得不那么频繁，但它们是 FA-OIT 停止的常见原因。必须对患者及其家属进行培训，以在家中管理这些反应。长期副作用也可能发生，如嗜酸性食管炎。儿科医生在维持患者积极性方面发挥着重要作用；他们还提供有关可能的过敏反应和致敏性共同因素（主要是发热和病毒感染、抗炎药物摄入、体力活动）的知识，并在需要长期护理时将患者转介给相关专家。目前正在研究食物免疫治疗的其他给药途径（皮内和舌下）和不同的佐剂治疗（益生菌、抗 IgE 分子）。这将使我们能够提高免疫治疗的疗效，降低任何副作用的风险，从而提供更有利的风险效益比。
