title: Novel immunotherapy approaches to food allergy.
abstract: OBJECTIVE
  Despite reaching high percentages of desensitization using allergen-specific immunotherapy (SIT) in patients with food allergy, recent studies suggest only a low number of patients to reach persistent clinical tolerance. This review describes current developments in strategies to improve safety and long-term efficacy of SIT.
  
  
  RESULTS
  Modified allergens or tolerogenic peptides, ultimately optimized for human leukocyte antigen background of the patient, are explored for tolerance induction, whereas anti-IgE antibody (Omalizumab) may be used to facilitate SIT safety. Adjunct therapies to enhance efficacy may make use of TH1 polarizing agents, for example, CpG-oligodeoxynucleotides combined with modified allergen packaged in nanoparticles. Preclinical studies showed insulin-like growth factor-2, intravenous immunoglobulin, Tregitopes or allergen encased oligomannose-coated liposomes capable of inducing regulatory T-cells, recognized for their importance in clinical tolerance induction. Dietary intervention strategies utilizing herbal formula 2, VSL#3, nondigestible short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS) plus Bifidobacterium breve M-16V or n-3 long-chain polyunsaturated fatty acids may facilitate safety and/or a favourable milieu for tolerance induction.
  
  
  CONCLUSIONS
  Combining SIT using (adapted) allergens or tolerogenic peptides with adjunct therapy may be essential to improve safety and/or efficacy. Beyond using targeted approaches, specific dietary components may be explored to reduce side-effects and support clinical tolerance induction by SIT.
authors.affiliation: aDepartment of Dermatology and Allergology, Utrecht Medical Centre Utrecht, Utrecht University bDivision of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University cNutricia Research B.V., Centre for Specialised Nutrition dLaboratory of Translational Immunology, Utrecht Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
authors.forename: Simone M
authors.initials: SM
authors.lastname: Hayen
authors.forename: Atanaska I
authors.initials: AI
authors.lastname: Kostadinova
authors.forename: Johan
authors.initials: J
authors.lastname: Garssen
authors.forename: Henny G
authors.initials: HG
authors.lastname: Otten
authors.forename: Linette E M
authors.initials: LE
authors.lastname: Willemsen
mesh_terms: D000485:Allergens / Q000627:therapeutic use*; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D003888:Desensitization, Immunologic / Q000379:methods*; D005512:Food Hypersensitivity / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D018417:Th1 Cells / Q000276:immunology
chemical_list: D000485:Allergens; D018926:Anti-Allergic Agents; D007155:Immunologic Factors