Immunotherapy in the treatment of food allergy: focus on oral tolerance.
OBJECTIVE
Food allergy is a serious and growing problem. Although the current standard of care for patients with food allergies is based on avoidance of the trigger, increased understanding of the mechanisms involved in oral tolerance has shifted focus of treatment and prevention toward inducing tolerance. Here we discuss the relationship of food allergy to oral tolerance and review recent oral tolerance studies, focusing on the mechanistic role of antigen presenting cells and the generation of regulatory T cells in mice and humans.


RESULTS
Specialized intestinal antigen presenting cells are conditioned by spatial and soluble microenvironmental factors to promote tolerance to dietary antigen primarily via the induction of regulatory T cells. Retinoic acid, a vitamin A metabolite, has been recently identified as a key environmental factor in this process.


CONCLUSIONS
Future clinical trials for food allergy immunotherapy will benefit from approaches, which target the oral tolerance pathways currently being elucidated.
Vickery
Brian P
BP
Department of Pediatrics, Division of Allergy and Immunology, Duke University Medical Center, Durham, North Carolina 27710, USA. brian.vickery@duke.edu
Burks
A Wesley
AW
D000284:Administration, Oral; D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects; D000818:Animals; D000938:Antigen-Presenting Cells / Q000276:immunology; D002986:Clinical Trials as Topic; D003888:Desensitization, Immunologic; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000009:adverse effects; D005512:Food Hypersensitivity / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007108:Immune Tolerance; D007155:Immunologic Factors / Q000276:immunology; D051379:Mice; D015166:Monitoring, Immunologic; D050378:T-Lymphocytes, Regulatory / Q000276:immunology; D014212:Tretinoin / Q000276:immunology
D000485:Allergens; D004044:Dietary Proteins; D007155:Immunologic Factors; D014212:Tretinoin