Food allergy: mechanisms and therapeutics

The immunologic mechanisms responsible for the development of allergic sensitization rather than tolerance to foods are not well understood, although there have been a number of recent advances in our understanding of why some foods are inherently allergenic. In addition, the involvement of alternative routes of exposure that are not inherently tolerogenic may play a role in sensitization to foods. Although there are no currently accepted therapeutic approaches to food allergy, there are a number of approaches to treatment in preclinical or clinical trials. Here, we review selected findings published since 2009 that advance our understanding of mechanisms and new therapeutics for IgE-mediated food allergy.

► Gut dendritic cells mediate tolerance to fed antigens via regulatory T cells. ► Exposure through non-oral routes such as the skin may promote sensitization. ► Food allergens can directly activate the innate immune system. ► Treatments being studied include allergen-specific and non-specific strategies. ► Oral immunotherapy shows promise but additional studies are needed.