State of the art and perspectives in food allergy (part II): therapy.

Currently management of food allergy is mainly based on absolute avoidance of the offending food(s) and the use of rescue medication. However, the risk of severe or life-threatening reactions due to inadvertent exposure, nutritional imbalance and social isolation raises the demand of disease-modifying treatments. The aim of the different treatments is to allow patients to safely ingest the offending food(s). However this unresponsiveness can be transient and requires continued treatment (desensitization) and has to be permanent and sustained also after stopping the treatment (tolerance). This review focuses on non-allergen specific (anti-IgE, Chinese herbal formula, etc..) and allergen specific treatments for food allergy. The anti-IgE treatment is at the moment the only non-allergen-specific therapy, for which some data on a temporarily clinical efficacy have been provided. Regarding allergen-specific treatments, different protocols (oral, sublingual, subcutaneous and epicutaneous) with natural, heat treated or recombinant food allergens have been investigated. Although promising, results of the different clinical trials are heterogeneous. In particular data on long-term effects are lacking. At the moment food specific immunotherapy can be considered an experimental interventional strategy, limited to research, and not yet ready for routine use.