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Treating food allergies: Is there light at the horizon?

Dietary elimination is currently the only way to treat food allergies. Unfortunately they have a huge, very limiting impact on the patients’ everyday life and there is an enormous fear of anaphylaxis. But there is light at the horizon! MeinAllergiePortal spoke to food allergy expert Hugh A. Sampson, MD, on new therapeutic options regarding diagnostics and treatments of food allergies. He is Professor of Pediatrics, Allergy and Immunology at The Mount Sinai Hospital in New York, USA.

Dr. Sampson, which methods for the treatment of food allergies are currently being developed?

Right now there are two forms of treatment that have completed phase-III-trials. One is epicutaneous immunotherapy, which is using a patch and was developed by DBV Technologies. The company has submitted their application to the FDA and is now waiting for review.

Another form of treatment of food allergies is an oral immunotherapy, developed by Aimmune Therapeutics. They have finished their phase-III-trial and just published a manuscript1) describing the study in The New England Journal of Medicine. I believe that Aimmune Therapeutics is planning on filing with the FDA before the end of the year.

Apart from those two, a variety of other therapeutic strategies are being researched.

What else is being researched?

Another therapeutic strategy under development is a subcutaneous immunotherapy with a modified peanut protein, which is in a phase-I-trial.

Then there is LAMPVaxTM, a DNA-vaccine, that is in a phase-I-trial. LAMP stands for Lysosomal Associated Membrane Protein.

Another therapeutic path being researched is immunotherapy in combination with Omalizumab, respectively anti-IgE. A couple of small studies have been published, and a larger study is being initiated.

A study on oral immunotherapy with Dupilumab is starting as well. Before, Dupilumab was examined in respect to the treatment of eosinophilic oesophagitis (EoE). In current studies one addresses the question, if Dupilumab could be used for the treatment of peanut allergieslergies in combination with immunotherapy. The aim is to suppress possible adverse reactions and also to promote tolerance or a more sustained response than we can observe with traditional immunotherapy.

There also will be another study coming out utilizing nanoparticles. This means that peanut protein is incorporated into nanoparticles, which also contain DNA components. It is expected that these DNA components will lead to nanoparticles being taken up more rapidly by antigen presenting cells. This study is still in pre-phase-I-stage.

Are all studies you mentioned targeting peanut allergy?

Most of the therapies researched are targeting peanut allergy. But these are more or less prototypes for future therapeutics.

Past peanut allergy studies have shown, that the protective effect of immunotherapy does not last beyond the end of treatment, is this also the case with, e.g., epicutaneous therapy?

Oral immunotherapy has been around for well over one hundred years, so there is a fair amount of experience. It has been shown that most individuals will lose protection after stopping therapy for a period of time.

It is not clear, whether or not epicutaneous immunotherapy will result in a more sustained response, because there are no long term studies beyond three years yet. The mouse models suggest, that the effect might be more sustained, but there is no data in humans, at this point, to support that.    

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