Oral desensitization in IgE-mediated food allergy: Effectiveness and safety

The avoidance of allergenic foods and emergency medications on accidental exposure are the only currently approved treatments in food allergy. EAACI guideline on allergen immunotherapy recommends oral immunotherapy as a therapeutic option to increase the threshold of the reaction during treatment in children with persistent IgE-mediated cow's milk, hen's egg, and peanut allergy from around 4-5 years of age, but the same recommendation cannot currently be made to achieve post-discontinuation effectiveness. Both systemic and local reactions during OIT have been frequently reported. For this reason, EAACI guideline suggests several recommendations on safety, including carefully monitoring patients for allergic reactions, especially during the up-dosing phase of OIT, and monitoring for symptoms of new-onset eosinophilic esophagitis. New approaches are certainly necessary to give priority not only to effectiveness but also to safety.