Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

Frontiers in Immunology

Silvia Ricci²  Elio Novembre³  Ermanno Baldo⁴  Davide Caimmi⁶  Giulia Liccioli⁷  Lucia Liotti⁸  Simona Barni⁸  Lucrezia Sarti⁸  Francesca Mori⁸  Umit Sahiner⁸  Mattia Giovannini⁸  Rodrigo Jiménez-Saiz^1,13  Daniel Munblit^1,14  Benedetta Biagioni^1,15 

[1] Oncology, Centro Nacional de Biotecnología (CNB)-CSIC, Madrid, Spain;0Department of Pediatrics, Salesi Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Ospedali Riuniti Ancona, Ancona, Italy;1Division of Immunology, Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children’s Hospital, Florence, Italy;2Department of Pediatric Allergy, Hacettepe University, Ankara, Turkey;3“Giovan Battista Mattei” Research Institute, Stenico, Italy;4Allergy Unit, CHU de Montpellier, Univ Montpellier, Montpellier, France;Allergy Outpatient Clinic, Division of Internal Medicine, IRCCS Azienda Ospedaliera Universitaria, Bologna, Italy;Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy;;Department of Immunology &Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain;Department of Medicine, McMaster University, Hamilton, ON, Canada;Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;Faculty of Experimental Sciences, Universidad Francisco de Vitoria (UFV), Madrid, Spain;Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom;Research and Clinical Center for Neuropsychiatry, Moscow, Russia;

关键词: food allergy;    oral immunotherapy;    IgE;    reaction;    anaphylaxis;    pediatrics;   

DOI  :  10.3389/fimmu.2021.636612

来源: DOAJ

【 摘 要 】

The prevalence of food allergy has increased in recent years, especially in children. Allergen avoidance, and drugs in case of an allergic reaction, remains the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanut, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization through the consumption of an increasing amount of a food allergen, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current pediatric OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, pediatric OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.

【 授权许可】

Unknown