New insights in the optimal diagnosis and management of food allergy.

Background: In recent years, food allergy has become a rising global epidemic, more so in Western countries. Although genetics may play a role in this increase, there are many other factors that have contributed to the upsurge. Recent research has shown that introducing allergenic foods to infants at an early age can reduce the risk of developing allergies to those foods. This is a substantial departure from traditional advice, which had recommended delaying the introduction of potential allergenic foods until a child was at least 1 year old and, in some cases, until the child was much older. Objective: The purpose of the present report is to review the epidemiology, mechanisms, and new prevention strategies for food allergies, and to discuss new treatment modalities associated with immune tolerance, which include the use of biologics as well as new forms of allergen immunotherapy (AIT) such as oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT), which have particular relevance for the allergist/immunologist. Results: Innovative developments in the treatment of food allergies have emerged through improved comprehension of immune tolerance and the induction of regulatory T (Treg) cells, the understanding of T-helper type 2 (Th2) cell-driven responses and their associated proinflammatory cytokine production, epitope mapping techniques, and the utilization of drugs such as monoclonal antibodies that target interleukin (IL) 4, IL-5, and IL-13 to disrupt Th2 cell-related pathways. In addition, there have been significant advancements in new forms AIT methods, which include OIT, SLIT, and EPIT. Conclusion: The present report reviews several of the many aspects of food allergy that have been impacted by this new knowledge and which have led to new insights for the optimal diagnosis and management of food allergy, and has had important implications for the diagnosis, treatment, prevention, and management of these conditions. The improved understanding of Treg-related mechanisms of immune tolerance and Th2 cell-driven responses associated with the production of proinflammatory cytokines associated with these responses, together with epitope mapping techniques, have played a crucial role in enhancing the diagnosis and management of food allergies. By identifying these variables, the allergist/immunologist is better equipped to tailor new diagnostic approaches and develop targeted therapies to significantly impact the lives of individuals affected by food allergies.