Current trends in pediatric food oral immunotherapy - early start, low dose and long maintenance, multi-food protocols

Abstract

Background: Oral immunotherapy (OIT) has been the best studied therapeutic approach for the treatment of food allergy over the past decade, with clinical trials evaluating its efficacy, safety and ability to improve participants' quality of life. 

Methods:  we review trends in the evolution of treatment regimens, beneficial and side effects of current OIT protocols for single or multi food allergy. We report conclusions drawn from the publication of some studies and a meta-analysis that highlighted the drawbacks of OIT, as well as  studies concerning multi-food oral immunotherapy. 

Results: OIT protocol with a low maintenance dose, slow progression, early onset even at preschool age and tailored to the severity phenotype has shown significant feasibility, efficacy and safety, offering a promising option for the management of patients with severe food allergy. Studies have also shown that a short course of omalizumab can safely accelerate the OIT schedule for multiple allergens simultaneously.  Therapeutic education and informed shared decision-making between patients and the medical team are essential. 

Conclusions: According to literature data and for reasons of safety, cost-effectiveness and logistics, OIT protocols are mainly aimed at single food allergy cases. This approach is becoming increasingly complex, as multiple food allergies (30% of cases) are generally more severe, have a greater impact on quality of life, and are less likely to resolve spontaneously over time. Future research should evaluate the short- and long-term effectiveness of this therapy in the real world, predictors of efficacy, and the use of adjunctive therapies that may mitigate adverse events.