Update on oral and epicutaneous immunotherapy for children with food allergy

Abstract

Purpose

Several oral immunotherapies (OITs) are used to treat food allergies. Recently, several protocols have been implemented to ensure the safety of OITs with a growing trend towards implementing them in a larger patient population. Additionally, reports on follow-up immunotherapy using the transdermal route have been reported. In this review, we summarize the evidence on current immunotherapies for food allergy.

Methods

We selected and reviewed studies on OIT and epicutaneous immunotherapy (EPIT) that showed evidence of clinical efficacy and safety in patients with an immediate type of food allergy.

Results

Continuation of low-dose OIT is considered relatively safe in patients with severe food allergies with a gradual increase in the daily dose of the immunotherapeutic agents. OIT products could be introduced through desensitization protocols to prevent serious adverse reactions; however, appropriate methods should be used to continue their use. Combining omalizumab, antihistamines, or probiotics with OITs improves the safety. Compared to OIT, EPIT is generally safer but has a lower efficacy. Furthermore, OIT is effective in some young patients. However, the selection of participants in such cases is critical from a safety perspective. Long-term OIT at relatively high target doses is associated with serious safety concerns.

Conclusion

The implementation of recent treatment protocols has significantly improved the safety of OIT. Therefore, its continuation using safety protocols can be considered in the selection of the optimal OIT for individual patients, as provision of safe and effective treatment is crucial for the success of OIT.