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Pediatr Allergy Immunol. 2016 Dec;27(8):784-794. doi: 10.1111/pai.12620. Epub 2016 Sep 16.

Specific oral tolerance induction in childhood.

Peters RL1, Dang TD1,2, Allen KJ1,2,3,4.

Author information

1
Centre of Food and Allergy Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia.
2
Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.
3
Department of Allergy and Clinical Immunology, Department of Gastroenterology, Clinical Nutrition Royal Children's Hospital, Melbourne, Vic., Australia.
4
Institute of Inflammation and Repair, University of Manchester, Manchester, UK.

Abstract

Food allergy continues to be a significant public health concern for which there are no approved treatments and management strategies primarily include allergen avoidance and pharmacological measures for accidental exposures. Food allergy is thought to result from either a failure to establish oral tolerance or the breakdown of existing oral tolerance, and therefore, experimental preventative and treatment strategies are now aimed at inducing specific oral tolerance. This may occur in infancy prior to the development of food allergy through the optimal timing of dietary exposure (primary oral tolerance induction) or as a treatment for established food allergy through oral immunotherapy (secondary oral tolerance induction). Trials examining the effectiveness of early dietary allergen exposure to prevent food allergy have yielded promising results for peanut allergy but not so for other allergens, although the results of several trials are yet to be published. Although infant feeding guidelines no longer advise to avoid allergenic foods and exposure to food allergens orally is an important step in inducing food tolerance by the immune system, evidence regarding the optimal timing, dose and form of these foods into the infant's diet is lacking. Likewise, oral immunotherapy trials appear promising for inducing desensitization; however, the long-term efficacy in achieving sustained desensitization and optimal protocols to achieve this is unknown. More research is needed in this emerging field.

KEYWORDS:

Food allergy; egg; infant feeding; milk; oral immunotherapy; oral tolerance; peanut

PMID:
27496561
DOI:
10.1111/pai.12620
[Indexed for MEDLINE]

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