● Strict avoidance of food allergens, along with early recognition and management of allergic reactions, is essential in preventing serious health consequences for individuals with food allergies.
● In February 2024, the U.S. Food and Drug Administration (FDA) approved the injectable biologic medication Xolair® (omalizumab) for treating food allergies in certain adults and children aged 1 year and older. Xolair reduces Type I allergic reactions, including the risk of anaphylaxis. In clinical trials, participants who were allergic to peanuts and at least two other foods received Xolair for 16 weeks. Two-thirds of the treatment group were able to tolerate a significant number of peanuts, compared to only 7% in the placebo group. While Xolair increased the allergic reaction threshold for peanuts and other common allergens, patients must continue avoiding the foods they are allergic to and carry epinephrine autoinjectors.
● The FDA approved Palforzia®, an oral peanut-based treatment for peanut allergies, in January 2020. However, this treatment is not suitable for all peanut-allergic individuals and is only approved for patients aged 4 to 17.
● Several immunotherapy approaches are being explored. Immunotherapy involves controlled exposure to food allergens, starting with very small amounts that are gradually increased according to the treatment protocol. The aim is to raise the threshold at which food allergens trigger allergic reactions. Successful immunotherapy can allow individuals to consume more of the allergenic food without having a reaction. However, this tolerance can be lost if the food is not consumed regularly. Immunotherapy results in sustained unresponsiveness when a patient can safely eat the allergenic food after discontinuing exposure for a period, though this typically lasts only a few weeks to several months.
● Some therapies currently under investigation include:
⦁ Oral Immunotherapy (OIT): This therapy aims to raise the threshold at which food allergy reactions occur. Under medical supervision, progressively larger amounts of the allergen are consumed, typically every two weeks, until a maintenance dose is reached. Once this level is achieved, the allergen is ingested regularly, usually three times per week. The success rates of OIT, in terms of desensitization and increased tolerance to food allergens, vary widely across trials, ranging from 30% to over 90% of participants. However, OIT can have serious side effects, including anaphylaxis and eosinophilic esophagitis.
⦁ Sublingual Immunotherapy (SLIT): In SLIT, a food protein is dissolved in liquid and held under the tongue for a short period before being either spit out or swallowed. Similar to OIT, the allergen dose is gradually increased over time until a maintenance dose is achieved. However, the doses used in SLIT are typically smaller. The level of desensitization achieved with SLIT can be comparable to that of OIT, but SLIT is less likely to result in serious allergic reactions.
⦁ Epicutaneous Immunotherapy (EPIT, or Skin Patch): EPIT delivers food proteins through patches applied to the skin. Clinical trials have shown that EPIT can help desensitize children aged 4–11 to peanuts. Compared to OIT, EPIT has a more favourable safety profile. However, this therapy is still under clinical investigation and has not yet been approved by the U.S. Food and Drug Administration (FDA).
● In food allergy immunotherapy clinical trials that reported racial demographic data, Black and Hispanic/Latino participants together represented only 4% of the total trial participants.
Both oral immunotherapy (OIT) and sublingual immunotherapy (SLIT) are being administered in clinical trials as well as in private practice.Fare – Food Allergy Research & Education
● In February 2024, the U.S. Food and Drug Administration (FDA) approved the injectable biologic medication Xolair® (omalizumab) for treating food allergies in certain adults and children aged 1 year and older. Xolair reduces Type I allergic reactions, including the risk of anaphylaxis. In clinical trials, participants who were allergic to peanuts and at least two other foods received Xolair for 16 weeks. Two-thirds of the treatment group were able to tolerate a significant number of peanuts, compared to only 7% in the placebo group. While Xolair increased the allergic reaction threshold for peanuts and other common allergens, patients must continue avoiding the foods they are allergic to and carry epinephrine autoinjectors.
● The FDA approved Palforzia®, an oral peanut-based treatment for peanut allergies, in January 2020. However, this treatment is not suitable for all peanut-allergic individuals and is only approved for patients aged 4 to 17.
● Several immunotherapy approaches are being explored. Immunotherapy involves controlled exposure to food allergens, starting with very small amounts that are gradually increased according to the treatment protocol. The aim is to raise the threshold at which food allergens trigger allergic reactions. Successful immunotherapy can allow individuals to consume more of the allergenic food without having a reaction. However, this tolerance can be lost if the food is not consumed regularly. Immunotherapy results in sustained unresponsiveness when a patient can safely eat the allergenic food after discontinuing exposure for a period, though this typically lasts only a few weeks to several months.
● Some therapies currently under investigation include:
⦁ Oral Immunotherapy (OIT): This therapy aims to raise the threshold at which food allergy reactions occur. Under medical supervision, progressively larger amounts of the allergen are consumed, typically every two weeks, until a maintenance dose is reached. Once this level is achieved, the allergen is ingested regularly, usually three times per week. The success rates of OIT, in terms of desensitization and increased tolerance to food allergens, vary widely across trials, ranging from 30% to over 90% of participants. However, OIT can have serious side effects, including anaphylaxis and eosinophilic esophagitis.
⦁ Sublingual Immunotherapy (SLIT): In SLIT, a food protein is dissolved in liquid and held under the tongue for a short period before being either spit out or swallowed. Similar to OIT, the allergen dose is gradually increased over time until a maintenance dose is achieved. However, the doses used in SLIT are typically smaller. The level of desensitization achieved with SLIT can be comparable to that of OIT, but SLIT is less likely to result in serious allergic reactions.
⦁ Epicutaneous Immunotherapy (EPIT, or Skin Patch): EPIT delivers food proteins through patches applied to the skin. Clinical trials have shown that EPIT can help desensitize children aged 4–11 to peanuts. Compared to OIT, EPIT has a more favourable safety profile. However, this therapy is still under clinical investigation and has not yet been approved by the U.S. Food and Drug Administration (FDA).
● In food allergy immunotherapy clinical trials that reported racial demographic data, Black and Hispanic/Latino participants together represented only 4% of the total trial participants.
