Sublingual and oral food immunotherapy: Indications, preparation, and administration
Richard F. Lockey, Dennis K. Ledford in Allergens and Allergen Immunotherapy, 2020
Food allergy diagnosis is complex, and there is no single universal method that meets the criteria of safety, sensitivity, and specificity to diagnose a food allergy. A diagnosis of food allergy often requires consideration of patient clinical history, measurement of specific IgE, elimination diets, and food challenges. Both skin prick wheal size and serum IgE levels assist in the diagnosis of allergy, but they have high sensitivities and low specificities and are associated with a high number of false positives [16,24,25]. At the current time, the double-blind, placebo-controlled food challenge (DBPCFC) remains the gold standard for diagnosing an IgE-mediated food allergy; however, it is resource consuming and carries with it the risk of severe reaction during challenge [24].
Food allergies and eosinophilic gastrointestinal diseases
Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald in Principles of Mucosal Immunology, 2020
As mentioned earlier, food elimination diets are currently the most effective treatment of food allergy. Ongoing studies are examining whether oral or skin patch administration of small doses of food allergens can desensitize atopic individuals to protect against severe anaphylactic responses to accidental food exposure. The nature of the anaphylactic response makes this approach inherently risky and requires that allergen dosing be confined to a carefully controlled medical setting. The realistic goal of this therapy is not to make allergic individuals completely tolerant to food proteins but to use immunologic tolerance to raise the antigen threshold to a level beyond that induced by contaminants in poorly labeled foods. This is particularly relevant to peanut sensitization where raising the threshold for triggering anaphylaxis from trace amounts to gram amounts is potentially life-saving.
Food Allergy
Praveen S. Goday, Cassandra L. S. Walia in Pediatric Nutrition for Dietitians, 2022
A food allergy is an adverse immunologic response to an ingested food protein. Food allergy involves either immunoglobulin E (IgE)-mediated or non-IgE-mediated immune mechanisms, each of which has a different clinical presentation and natural history. Milk, egg, peanut, soy, wheat, tree nut, fish, and shellfish cause approximately 90% of food allergies in children in the USA, and diets restricting these foods can pose nutritional challenges for pediatric patients. Though food allergy prevalence has risen in recent decades, emerging data suggests that introducing allergens early in life may prevent food allergy development in infants and children.
Hypersensitivity and adverse reactions to biologics for asthma and allergic diseases
Published in Expert Review of Clinical Immunology, 2020
Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory disease of the esophagus. The pathogenesis is not completely understood but seems to involve multiple mechanisms. In some patients, food hypersensitivity seems to play a role. The basic treatment is swallowed corticosteroid (budesonide slur) and elimination of identified causative food(s) [64,65] showed inconsistent results (Table 4) [66]. Trials of anti-IgE [67] and anti-IL5 agents [68–71] showed inconsistent efficacy. Biologics targeting IL13 and IL4 have demonstrated promising results [66]. Anti-IL13 agents demonstrated a significant reduction in endoscopic findings and mucosal eosinophil severity but insignificant improvement in GI symptom [72,73]. Dupilumab showed significant improvement in both symptoms and endoscopic features in 47 patients followed for 12 weeks after receiving dupilumab 600 mg first loading dose followed with 300 mg weekly [74]. Additional trials are being conducted to validate these results and to clarify the role of blocking IL13 and IL4 in the management of EoE. To date, none of the biologic agents have received FDA approval for EoE.
Current Trend in Immunotherapy for Peanut Allergy
Published in International Reviews of Immunology, 2018
Chong Joo Chan, Timmy Richardo, Renee Lay Hong Lim
Food allergy is an important public health problem that affects children and adults worldwide. Unlike food intolerance that is a common reaction and is a less serious condition, food allergy is an abnormal response to a food triggered by the body’s immune system.1 Even a small amount of the allergy-causing food can trigger symptoms ranging from merely digestive problems, hives or swollen airways to a life-threatening anaphylaxis reaction. Sensitisation to food allergens can occur either in the gastrointestinal tract (class I food allergy) or as a consequence of cross reactivity to structurally homologous inhalant allergens (class II food allergy). Food allergy can be broadly divided into those that are IgE mediated and those that are non-IgE mediated, the former results in acute onset of symptoms after food ingestion. The IgE-mediated food allergy can be either class I, involves primary sensitisers that occurs in the gastrointestinal tract and accounted for systemic reactions and or class II food allergy caused by cross reactivity to structurally homologous inhalant allergens.1 Milk (casein), egg (ovomucoid), and peanut allergens (Vicillin, conglutin, glycinin) are class I, food allergens which are highly stable and can retain under acidic, heat and protease condition, whereas class II allergens (example Bet v1) are heat labile and susceptible to digestive process.
Intolerance of uncertainty and protective parenting in mothers of children with food allergy
Published in Children's Health Care, 2020
Emily M. Steiner, Lynnda M. Dahlquist, Thomas G. Power, Mary Elizabeth Bollinger
Uncertainty is particularly salient in some chronic health conditions, such as food allergy. Nearly 8% of children in the United States have some form of food allergy (Gupta et al., 2011). These allergies often develop in the first or second year of life and some, such as nut and seafood allergies, can be lifelong. Food allergy is an immunologic reaction to food mediated through immunoglobin E (IgE) antibody (Wood, 2003). Food allergen exposure may lead to symptoms such as rash, swelling, shock as well as gastrointestinal, throat, respiratory, and heart symptoms. Anaphylaxis, a severe allergic reaction, can cause circulatory collapse, coma, and even death (Broome, Lutz, & Cook, 2015). Currently, the only treatment for food allergy is avoidance of the implicated food. Caregivers are solely responsible for protecting their children from food allergen exposure until their children are developmentally able to manage their exposure independently. Caregivers need to learn what foods are safe for their child to eat, read food labels, remain vigilant about what their child consumes, and maintain communication with teachers, other caregivers, and health care providers (Peterson-Sweeney, McMullen, Yoos, & Kitzman, 2003; Wood, 2003).
Related Knowledge Centers
- Milk
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