Oral and sublingual immunotherapy for food allergy: current progress and future directions

•OIT/SLIT can desensitize patients with food allergy.•Methods for improving OIT/SLIT safety and long-term efficacy are needed.•Modification of food allergens may enhance OIT/SLIT safety.•Adjunct immunomodulatory agents may improve OIT/SLIT efficacy.•OIT/SLIT are presently investigational and not ready for routine clinical use.

Food allergies are increasing in prevalence and present an emerging epidemic for westernized countries. Strict dietary avoidance is the only approved management for food allergy, but accidental exposures regularly occur, leading to significant patient anxiety and decreased quality of life. Over the past decade, oral and sublingual immunotherapies have emerged as potential treatments for food allergy. While several small clinical trials have demonstrated that immunotherapy can desensitize food-allergic individuals, strategies for further enhancing safety and definitively establishing long-term efficacy are needed. This review presents an overview of recent oral and sublingual immunotherapy trials, and provides a glimpse into what the next generation of food immunotherapy may entail.