Beyond allergen avoidance: Update on developing therapies for peanut allergy

Purpose of review: Food allergy has emerged as a significant health problem. Peanut allergy is a major cause of food-induced fatal and near fatal anaphylactic reactions, and the incidence in children is increasing. Attempts to manage peanut allergy by strict avoidance are often unsuccessful. The purpose of this review is to highlight the most promising novel approaches for treating peanut allergy beyond allergen avoidance. Recent findings: In the past 5 years much effort has been devoted to developing a treatment for peanut allergy. A recent clinical trial showed that monthly injections of humanized recombinant anti-IgE antibodies increased the threshold for allergic responses of peanut-sensitive individuals, at least to small amounts of peanut protein. However, this treatment cannot cure peanut allergy, and continuous monthly injections are necessary to maintain protection. Developing now therapies for the treatment of peanut allergy is essential. In reviewing publications between 2003 and 2005, several novel therapeutic approaches, tested in the murine model of peanut anaphylaxis appeared promising. Immunotherapy with engineered recombinant peanut protein and bacterial adjuvant significantly protected peanut allergic mice from anaphylaxis. It was also found that a Chinese herbal medicine formula called Food Allergy Herbal Formula-2 completely blocked anaphylaxis up to 5 weeks following therapy. These potent therapeutic effects are asspciated with immunoregulaiton of Th1 and Th2 responses. Summary: Although there is no effective and safe therapy for food allergy, many novel approaches are under investigation. Some of these approaches may provide allergists with effective treatments in the near future.