Food allergy: Update on clinical interventions leading to desensitization and tolerance

Food allergy refers to an immune-mediated response to a food protein, and can be further divided into IgE-mediated, non-IgE-mediated, and mixed mechanisms. A significant proportion of Western society is affected, ranging from 1 to 2% but less than 10% of the population according to a recent systematic review. A breakdown in oral tolerance leads to the development of food allergy and is characterized by a heightened Th2 response in an allergic individual leading to an increase in the production of food-allergen specific IgE. Upon re-exposure to a food allergen, allergen-specific IgE bound to mast cells is cross-linked causing a release of inflammatory mediators manifesting symptomatically as an allergic reaction. The current standard treatment is avoidance of the provocative food allergen. Ongoing research is intensely studying novel ways of inducing desensitization and understanding which methods induce long-term tolerance. This review discusses our current understanding of the development of oral tolerance and takes a look at ongoing research investigating novel treatment modalities for IgE-mediated food allergies.