Current and future food allergy treatment has and will consist primarily of oral immunotherapy (OIT), sublingual immunotherapy (SLIT) and epicutaneous immunotherapy (EPIT), alone or in combination with Xolair (monoclonal IgE). However, other therapies are under current investigation. Despite advances in the field of food allergy treatment, the current therapies remain experimental because none of these approaches have FDA or other regulatory approval for use in patients. Here I will discuss treatments that are being studied for food allergies.
OIT has been studied most extensively in the form of milk, egg and peanut. OIT results in successful desensitization (reduced reactivity while receiving therapy) in a majority of treated subjects, but sustained unresponsiveness, which is defined as reduced clinical reactivity after a period of cessation of therapy, has been achieved in only a subset.
Peanut OIT with AR101 is currently in phase 3 clinical trials to assess this highly characterized peanut OIT product for efficacy and safety for the induction of clinical desensitization in peanut allergic children, results are anticipated in 1-2 years.
SLIT for IgE mediated food allergy has focused predominantly on treatment for patients allergic to milk, peanuts, tree nuts and fresh fruits. These studies have shown clinical efficacy with moderate allergen-specific desensitization and a low side effect profile limited to predominantly to oral mucosa symptoms. As with other forms of SLIT, limited conclusions can be made because of reduced participant adherence to therapy over time. More studies need to be done to realize the full utility in clinical care.
EPIT has been investigated for the treatment of peanut and milk allergy and involves daily application of an allergen patch to the back or upper arm. Currently trials are underway for Viaskin Peanut patch. Results have been mixed and ongoing phase 2 and phase 3 studies are in progress for both peanut and milk allergy, results should be forthcoming in the next 1-2 years.
Novel investigations are underway to target food allergy. A recent pilot study with dietary supplementation of isoflavones showed some potential. At Mount Sinai investigators used CpG coated polynanoparticles containing peanut extract to treat mice with peanut allergy. Chinese herbal therapy product (B-FAHF-2) is also being studied for peanut treatment.
The food allergy field is entering an exciting new ear with potential for lasting effect on disease burden. Current treatment strategies are not without associated risk and further investigation is needed to address existing knowledge gaps, including optimal dose, duration, maintenance regimen, long term outcomes, predictors of response, cost-effectiveness, and psychosocial effect that will maximize efficacy, minimize risk and develop individual treatment approaches. The future food allergy treatment options will positively affect patients and families affected by food allergy.