Treatment for food allergy

Publication date: January 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 1
Author(s): A. Wesley Burks, Hugh A. Sampson, Marshall Plaut, Gideon Lack, Cezmi A. Akdis
Information for Category 1 CME CreditCredit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.Date of Original Release: January 2018. Credit may be obtained for these courses until December 31, 2018.Copyright Statement: Copyright © 2018-2019. All rights reserved.Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.Target Audience: Physicians and researchers within the field of allergic disease.Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.List of Design Committee Members: A. Wesley Burks, MD, Hugh A. Sampson, MD, Marshall Plaut, MD, Gideon Lack, MB, BCh, FRCPCH, and Cezmi A. Akdis, MD (authors); Zuhair K. Ballas, MD (editor)Disclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: A. W. Burks reports personal fees from NIH AITC Review Panel, Allertein, American Society for Microbiology, Elsevier, FARE, World Allergy Organization, Adept Field Solutions, Aimmune Therapeutics, Inc, Astellas Pharma Global Development, Inc, Biomerica, Inc, Evelo Biosciences, Inc/Epiva Biosciences, Inc, First Manhattan Co, Genentech, GLG Research, Inc, Insys Therapeutics, Intrommune Therapeutics, PPD Development, LP, Regeneron Pharmceuticals, Inc, Sanofi US Services, SRA International, Stallergenes, UKKO, Inc, and Valeant Pharmaceuticals North America, LLC and reports grants from Food Allergy Research and Education (FARE), National Institutes of Health, and Wallace Research Foundation. H. A. Sampson has received grants from the National Institute of Allergy and Infectious Diseases (AI-44236, CoFar, ITN); has consultant arrangements with Allertein Therapeutics, LLC, Hycor, and UCB; is Chief Scientific Officer of DBV Technologies; has received royalties from UpToDate; and has stock/stock options with DBV Technologies. G. Lack has received grants from the National Institutes of Allergy and Infectious Diseases (NO1-AI-15416 [contract] and UM1AI109565 [grant]), Food Allergy Research and Education (FARE), MRC & Asthma UK Centre, UK Department of Health through the National Institute for Health Research, the National Peanut Board, and Osem; and has consultant arrangements and stock/stock options with DBV Technologies. C. A. Akdis has received grants from Actellion, the European Union projects Medall and Predicta, Allergopharma, the Swiss National Science Foundation, and the Christine Kühne Center for Allergy Research and Education. M. Plaut declares no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships.Activity Objectives:1. To understand the relative advantages and drawbacks of each of the 3 main forms of immunotherapy for food allergy (oral immunotherapy [OIT], sublingual immunotherapy [SLIT], and epicutaneous immunotherapy [EPIT]).2. To become familiar with the general protocol design for the different forms of food allergy immunotherapy.3. To know the difference in the commonly used terms in food allergy treatment: desensitization, sustained unresponsiveness, oral tolerance, and remission.Recognition of Commercial Support: This CME activity has not received external commercial support.List of CME Exam Authors: Amy CaJacob, MD, Miranda Curtiss, MD, PhD, Suthida Kankirawatana, MD, Njeri Maina, MD, PhD, Cali Reynolds, MD, and T. Prescott Atkinson, MD, PhDDisclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: The exam authors disclosed no relevant financial relationships.The prevalence of IgE-mediated food allergy is an increasing public health concern effecting millions of persons worldwide. The current standard of treatment is strict avoidance of the offending food or foods, and to date, there are no regulatory approved treatments for food allergy. A significant amount of research has been directed at various forms of food immunotherapy, including oral, sublingual, and epicutaneous delivery routes. Although oral immunotherapy has shown the greatest promise for efficacy in terms of the amount of protein that can be ingested, it has also demonstrated less tolerability and a less favorable safety profile compared with sublingual immunotherapy and epicutaneous immunotherapy, which offers the least protection but has the best safety and tolerability profile. Studies have been conducted with adding adjuvants and anti-IgE to enhance either the efficacy or safety of food immunotherapy. Multiple concepts of food immunotherapy beyond these first-generation treatments are in either animal or early phase 1 studies.



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