There is presently no cure for food allergy. Currently, healthcare providers can manage patients’ food allergies by encouraging them to avoid foods that may cause an allergic reaction and by treating severe reactions when they arise. But the rate of food allergic reactions are high—about one each year for allergic children, according to a 2012 NIAID-funded study.
To address this high rate, scientists are working to develop immunotherapy approaches to prevent and treat food allergy. Immunotherapy involves exposing the immune system to an allergen in a controlled way in order to eventually lessen the immune response to that allergen. This approach can take many forms, all of which are experimental. Immunotherapy is not currently approved by the Food and Drug Administration to treat food allergy. However, research to investigate different approaches to immunotherapy in food allergy is ongoing. NIAID-funded researchers have implemented several clinical trials to assess the effectiveness of different forms of immunotherapy for the treatment of food allergy. View all NIAID-sponsored clinical studies on immunotherapy for food allergy.
Oral immunotherapy, or OIT, is being tested in several NIAID-funded clinical trials to evaluate the role of OIT in treating and managing food allergy. OIT involves eating small doses of the food that causes the allergy—usually in the form of a powder mixed with a harmless food—and gradually increasing these doses every day. A 2012 study from the NIAID-funded Consortium of Food Allergy Research (CoFAR) suggested that egg OIT can benefit children with egg allergy. Most of the study participants could be safely exposed to egg while on egg OIT, and some were able to safely eat egg after stopping OIT.
In 2017, a NIAD-funded study called MAP-X found that a course of an additional medication, an injectable antibody called omalizumab, taken during OIT improved the safety of the therapy in children with allergies to several different foods. More than 80 percent of children who received omalizumab and OIT could safely consume two-gram portions of at least two foods to which they were allergic, compared with only a third of children who received placebo and OIT.
Now, in an ongoing NIAID-supported study known as OUtMATCH, researchers are testing the ability of biweekly or monthly injections of omalizumab—alone or together with multi-allergen OIT—to increase a person’s ability to tolerate multiple foods to which they are allergic. Investigators will enroll about 225 adults and children at 10 clinical CoFAR sites throughout the United States. Read more about OUtMATCH.
In epicutaneous immunotherapy, or EPIT, an allergen is delivered to the skin’s surface by a wearable patch. In 2016, CoFAR completed a study to evaluate the safety and efficacy of EPIT for peanut allergy. The therapy enabled recipients of the patch to tolerate larger amounts of peanut in a blinded oral food challenge after one year of treatment compared to the amounts they could tolerate in an oral food challenge at the start of the study.
For several allergy problems, like hay fever, health care providers may recommend subcutaneous immunotherapy, or allergy shots, in which allergens are injected directly into a person’s body. Researchers are no longer pursuing this approach as a treatment for food allergy because initial attempts too frequently caused severe allergic reactions.
Baked Milk and Egg Therapy
Consumption of food that includes baked milk or egg products is a potential alternative to OIT for treatment of milk and egg allergies. Temperature-associated changes in certain milk and egg proteins may render baked versions of these foods less allergenic. However, the same does not hold true for all allergy-triggering foods. For example, roasting peanuts can make them even more likely to cause allergic reactions.
Studies have suggested that some children who are allergic to uncooked egg and milk can tolerate small amounts of these foods in fully cooked products such as muffins. One NIAID-funded study in 2011 found that more than half of baked-milk-tolerant children were able to tolerate foods containing uncooked milk after caregivers followed specific instructions to include baked milk products into their diets. The results also suggested that children who consumed baked milk outgrew their milk allergies more quickly than children who did not. However, many of the children treated with baked products were never able to eat unheated milk without allergic reactions. Additional studies are needed to determine how beneficial the baked food approach can be for certain people with food allergy.