title: Use of biologics in severe food allergies.
abstract: OBJECTIVE
  Severe cases of food allergy account for the majority of the burden in terms of risks, quality of life, and resource expenditure. The traditional approach to these forms has been strict avoidance. More recently, Oral ImmunoTherapy (OIT) has gained a role in their management. However, in severe food allergies OIT is often infeasible.
  
  
  RESULTS
  Case reports, observational, and prospective studies have recently proposed different approaches to severe food allergy. The majority of them include the use of biologics. Omalizumab has been the most studied drug for severe food allergies, and its role as adjuvant treatment to OIT is well established. Interest has been raised on other biologics, as dupilumab, reslizumab, and mepolizumab. Toll-like receptor agonists, and gene therapy using adeno-associated virus coding for Omalizumab are promising alternatives.
  
  
  CONCLUSIONS
  The recent studies are deeply influencing the clinical practice. We review the modifications of the clinical approach to severe food allergies so far available. We indicate the possible evolutions of treatment with biologics in severe food allergies.
authors.affiliation: Ospedale Pediatrico Bambino Gesù, Dipartimento Pediatrico Universitario Ospedaliero (DPUO), UOC Allergologia, Rome, Vatican City, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiocchi
authors.forename: Valentina
authors.initials: V
authors.lastname: Pecora
authors.forename: Rocco L
authors.initials: RL
authors.lastname: Valluzzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fierro
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mennini
mesh_terms: D000284:Administration, Oral; D000818:Animals; D018926:Anti-Allergic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001685:Biological Factors / Q000627:therapeutic use*; D005512:Food Hypersensitivity / Q000628:therapy*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007167:Immunotherapy / Q000379:methods*; D053662:Interleukin-4 Receptor alpha Subunit / Q000276:immunology; D015848:Interleukin-5 / Q000276:immunology; D051193:Toll-Like Receptors / Q000037:antagonists & inhibitors
chemical_list: D018926:Anti-Allergic Agents; D000911:Antibodies, Monoclonal; D001685:Biological Factors; C504000:IL4R protein, human; D053662:Interleukin-4 Receptor alpha Subunit; D015848:Interleukin-5; D051193:Toll-Like Receptors; D007073:Immunoglobulin E