Recently, preparation of heated allergens in OIT for milk and/or egg allergy was evaluated based on evidence of temperature-associated changes in protein conformation and reduced IgE binding to heated allergens 8). Diluted whole milk 12, 42) and dry nonfat powdered milk 43) have been used in OIT procedures for patients with allergies to milk. Whole, crushed roasted peanuts were used as a food allergen in a European study 22). In the University of North Carolina OIT program, substances used as food allergens are screened for contamination by mold, yeast, Salmonella spp., Escherichia coli, and aflatoxin using appropriate bioassays. Studies have demonstrated that the allergenicity of commercially available dried egg powder is equivalent to raw egg whites, and that the processing involved in producing dried egg powder does not affect the allergenicity of egg proteins 41). Partially defatted peanut flour and dried egg powder are often used as food allergens in OIT procedures. After patients reach the target dose, they continue to eat the same dose daily at home and return for regular follow-up visits at the research clinic (e.g., once every 4 months). At the end of the 2-week period, patients return to the research clinic to eat the next increased dose. Patients continue to eat the same maximum tolerated dose daily at home for 2 weeks. Initial dose escalation begins in the research clinic on day 1, and patients eat their maximum tolerated dose of a food allergen, followed by 2 hours of observation in the research clinic on day 2. According to the author's experiences with OIT at the Consortium of Food Allergy Research (CoFAR), patients who completed screening tests, such as providing a detailed history, physical examination, serum specific IgE quantification, skin prick test, spirometry, peak flow meter visit research clinic for baseline OFC on day 0. In the United States, OIT protocols for food allergy typically comprise three phases: (1) an initial dose escalation or modified rush desensitization that takes place over 1–2 days with 6–8 doses of the allergen given, (2) a build-up phase that consists of weekly to biweekly dose escalations performed over 6–12 months until a target dose is reached, and (3) a maintenance phase with daily home dosing that occurs over the course of several months or years 8). Key words: Epicutaneous immunotherapy, Food allergy, Oral immunotherapy, Sublingual immunotherapy Although immunotherapy cannot be recommended for routine practice yet, results from recent studies demonstrate that immunotherapies are promising for the treatment of food allergy. Adverse reactions to these immunotherapies have usually been localized, but severe systemic reactions have been observed in some cases. In some studies, immunologic changes after immunotherapy for food allergy have been revealed. While various rates of desensitization (36% to 100%) and tolerance (28% to 75%) have been induced by immunotherapies for food allergy, no single established protocol has been shown to be both effective and safe. Recently, oral, sublingual, and epicutaneous immunotherapies have been studied for their effectiveness against food allergy. The current standard treatment of allergen avoidance and self-injectable epinephrine does not change the natural course of food allergy. Food allergy is common and sometimes life threatening for Korean children.
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