Current Status and Unanswered Questions for Food Allergy Treatments

Although there is no FDA approved therapy for food allergy, over the past decades, several routes of immunotherapy have been investigated for food allergy. Thus far, these therapies have shown variable levels of efficacy at desensitizing to foods, with oral immunotherapy (OIT) far more successful than sublingual immunotherapy (SLIT) or epicutaneous immunotherapy (EPIT). However, desensitization tends to be temporary, and safety remains a major concern with OIT. Moreover, although it seems logical that desensitization will result in fewer reactions, it is not clear whether OIT or other immunotherapies are associated with an overall lower or higher risk of reactions over the long term. Eosinophilic esophagitis is a known complication of OIT, and may also be a risk with SLIT and possibly EPIT, although it has not been reported in the relatively few patients treated thus far. Adjuvants such as omalizumab or probiotics may improve the safety and/or efficacy of immunotherapy for food allergy, but more research is needed. In the future, biomarkers may identify subsets of patients who are better candidates for specific treatments. As therapies become commercially available, patients and providers will need to consider whether the benefits justify the risks and burdens of these treatments.