Allergists continue to see an expanding number of patients with food allergy. At the same time, it appears that an increasing number of children are experiencing food allergies (aside from nut allergies) that persist through school age. This has prompted the urgent need for developing safe and effective treatments for food allergy. It is encouraging that in light of this pressing need, one or more treatment modalities for food allergy appears within reach.
Prevention of disease should always be the first and foremost objective. In this area, much remains to be done. Whether early introduction of potential allergens (likely in forms with reduced allergenic potential) is helpful remains to be proven. Providing the immune system with a “second signal” to enhance tolerance induction has shown some promise in various rodent models.
Of the treatments reviewed above, it appears that some form of orally delivered, allergen-specific immunotherapy is likely to provide the first clinically applicable therapeutic option. It must be emphasized, however, that several issues need clarification before this form of therapy will be approved for clinical use. The route, frequency, and dose will need to be standardized and the safety profile improved, with identification of biomarkers indicating those at greatest risk for reactions. It also will be important to elucidate the underlying immunologic mechanisms for these strategies and determine whether long-term oral tolerance is established.
Allergen-non specific treatments also have shown promise, not only in mice, but also in limited human trials. These forms of therapy are particularly attractive for the treatment of those patients with multiple food allergies in whom allergen-specific treatment of multiple allergies could literally take decades. The combination of allergen-specific with allergen-non specific therapies could potentially yield the greatest benefits.