Using food and Nutritional Strategies to Induce Tolerance in Food Allergic Children

Anna Nowak-Wegrzyn (Mount Sinai Hospital, USA) expanded on the theme of inducing tolerance in food allergic children. There is currently no evidence to suggest permanent tolerance can be induced with food immunotherapy. However, baked milk and egg products, which have an altered conformational structure of the relevant protein, have already been adopted into clinical practice where they have been shown to accelerate the development of tolerance to unheated milk/egg. This process often occurs naturally by age 6 years. Oral immunotherapy to treat peanut allergy is associated with a high rate of adverse reactions, whereas sublingual immunotherapy achieves only marginal desensitization and is further limited by the deliverable dose. Epicutaneous immunotherapy offers convenience in that it can be applied at home as a skin patch. It is also associated with a low level of desensitization in the case of peanut and milk allergies. Further data are needed to establish the efficacy of such strategies.