Towards immunotherapy for peanut allergy.
OBJECTIVE
Food allergy is a major cause of life-threatening hypersensitivity reactions. Peanut allergy is the most serious of the hypersensitivity reactions to foods due to its persistence and high risk of severe anaphylaxis. Currently, strict avoidance of the allergenic food and ready access to self-injectable epinephrine is the 'standard of care' for food allergy. Based on extensive characterization of food allergens and a better understanding of the immunological mechanisms underlying allergic disease, promising therapeutic modalities for food allergy treatment and prevention are being developed.


RESULTS
Immunotherapeutic strategies include peptide immunotherapy, mutated protein immunotherapy and DNA immunization, which all strive to decrease the deleterious Th2 response. Another approach already in clinical trials for peanut allergy is the anti-IgE therapy which prevents circulating IgE from binding to effector cells, consequently decreasing clinical symptoms after peanut ingestion. In order to be applicable, these strategies must be well tolerated, inexpensive and easily administered. Realistic treatment options would likely involve a combination of different approaches.


CONCLUSIONS
Food allergy affects approximately 4-6% of children and 3-4% of adults. Peanut allergy can be devastating as reactions range from urticaria to severe anaphylactic shock and death. The only preventive measure for peanut allergy is strict avoidance of the incriminating food. It is likely immunotherapy will be available in the near future as a well tolerated and effective therapy for treating peanut allergy. The use of the anti-IgE therapy in conjunction with other immunotherapy would possibly be the best treatment option in the future.
Pons
Laurent
L
Pediatric Allergy and Immunology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Palmer
Kricia
K
Burks
Wesley
W
D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D000818:Animals; D000906:Antibodies / Q000008:administration & dosage / Q000627:therapeutic use; D010367:Arachis / Q000009:adverse effects / Q000737:chemistry / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007167:Immunotherapy; D009154:Mutation; D021183:Peanut Hypersensitivity / Q000276:immunology / Q000628:therapy*; D010455:Peptides / Q000276:immunology; D010940:Plant Proteins / Q000737:chemistry / Q000235:genetics / Q000276:immunology; D018418:Th2 Cells; D014611:Vaccination; D019444:Vaccines, DNA / Q000008:administration & dosage / Q000276:immunology
D000485:Allergens; D000906:Antibodies; D010455:Peptides; D010940:Plant Proteins; D019444:Vaccines, DNA; D007073:Immunoglobulin E