Oral, sublingual, and dermatologic immunotherapy for food allergy

In the last few decades food allergy appears to be increasing in prevalence. Food allergy has a significant impact on the quality of life for patients and their caregivers, largely related to fear of unpredictable, and possibly severe, allergic reactions. As such, many families desire a treatment option that would reduce the risk of allergic reaction upon an accidental ingestion. Immunotherapy has been used successfully to desensitize patients with allergic rhinitis and asthma, and thus there is great interest in harnessing this approach to treat patients with food allergies.

To date, oral immunotherapy (OIT), epicutaneous immunotherapy (EPIT), and sublingual immunotherapy are the most extensively studied modes of immunotherapy for food allergy. For each of these therapies, research has progressed the furthest for patients with peanut allergy, although other treatment foods have been investigated as well. The first commercial OIT product for peanut allergy (Palforzia) was approved by the Food and Drug Administration and European Commission in 2020, and the first commercial EPIT product for the treatment of peanut allergy has concluded phase 3 studies. Each form of immunotherapy has strengths and limitations with regard to efficacy and safety, and decisions regarding whether to pursue immunotherapy and which approach to consider may need to be personalized for each patient and his/her family.