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Why Can't I Get Allergy Shots (Immunotherapy) For Food Allergies?

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Updated March 05, 2009

Question: Why Can't I Get Allergy Shots (Immunotherapy) For Food Allergies?
Answer:

The allergy shots that desensitize you to environmental allergens like pollen and pet dander are a form of immunotherapy. You may very well be able to take some form of immunotherapy for food allergies in the future. That immunotherapy will likely not be in the form of shots, and it's tough to predict exactly when such a treatment will be beyond the experimental phase, however.

Immunotherapy refers to any treatment that changes the immune system's response to some sort of negative antigen. Vaccines are a familiar form of immunotherapy, as are allergy shots and some experimental cancer treatments that use patients' own cancer cells.

In the most common food allergy immunotherapy being studied today, tiny quantities of an allergenic food (fractions of a gram) are given orally, often in the form of drops. The immunotherapy treatments are generally given in an allergist's office, hospital, or research facility where supportive treatment is available in case of an adverse reaction.

Over the course of the treatment, researchers aim to gradually raise the amount of allergenic food the patient can tolerate, with an ultimate goal of being able to allow patients to eat foods they were previously allergic to. Thus far, published studies have been released on immunotherapy in patients with peanut, egg, hazelnut, and dairy, in addition to how immunotherapy affects oral allergy syndrome.

What's the catch? The major one is the risk-benefit profile of allergen immunotherapy in studies so far. There have been mixed results on both the risk side and the benefit side. While most reactions during immunotherapy are mild, large-scale studies of patients in immunotherapy have shown that some experience reactions severe enough to require epinephrine or asthma medication. (Some studies mitigate this risk by selecting only patients without a history of anaphylaxis or other very severe reactions.) Many experience skin or gastrointestinal symptoms, and some drop out of studies due to the side effects, though most do complete the immunotherapy.

On the benefit side, thus far, most patients who have received allergen-specific immunotherapy haven't been able to tolerate a whole serving of an allergen after a relatively long period of time (months or longer) has elapsed since their treatments. In one study of children with a history of very severe milk allergies, for example, just over one-third of patients were able to drink milk with no restrictions one year after treatments, and many more were able to tolerate small quantities. However, many patients who seem to develop tolerance to an allergen by the end of immunotherapy treatment lose that tolerance within a number of months.

The future of immunotherapy may include using different forms of food allergens to help the body develop tolerance or using a drug therapy in combination with immunotherapy. Researchers also need to determine which types of patients are most likely to benefit from immunotherapy and how quickly to increase the dosage of the allergens. Until and unless these questions are answered, immunotherapy remains intriguing but still experimental.

Sources:

Beyer, Kirsten and Ulrich Wahn. "Oral Immunotherapy for Food Allergy in Children." Current Opinion in Allergy and Clinical Immunology. Dec. 2008. 8(6): 553-56.

Longo, Giorgio, et al. "Specific Oral Tolerance Induction in Children with Very Severe Cow's Milk-Induced Reactions." Journal of Allergy and Clinical Immunology. 1 Feb. 2008. 121(2): 343-47.

Wood, Robert A. "Food Specific Immunotherapy: Past, Present & Future." Journal of Allergy and Clinical Immunology. 1 Feb. 2008. 121(2): 336-37.

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