Epicutaneous and sublingual immunotherapy: Efficacy, tolerance and place in the management of food allergy

Oral immunotherapy (OIT) is the only treatment usable in practice for inducing tolerance in food-allergic patients. However, adverse events often lead to OIT refusal or discontinuation. Epicutaneous (EPIT) and sublingual (SLIT) immunotherapies are protocols developed concurrently with OIT, mainly for peanut allergy. They share immunological principles, capitalizing on Langerhans cells found in oral and cutaneous tissues to induce regulatory T lymphocytes and produce allergen-specific immunoglobulin G4 (IgG4). However, both EPIT and SLIT expose patients to smaller amounts of allergen compared to OIT. EPIT and SLIT are usually well tolerated, and have a lower risk of anaphylaxis when compared to OIT. Despite the lack of studies offering direct comparison, the ability of EPIT and SLIT to increase the tolerance threshold while on treatment seems lower compared to OIT. However, it appears that they have similar potential to OIT in terms of adjusting allergen-specific IgE and IgG4 serological responses as well as disease progression, especially in the age group of 1-4. EPIT and SLIT appear as complementary treatments to OIT, promoting medium-to long-term tolerance in peanut-allergic patients. These treatments could have an indication in patients who are ineligible, have failed, or refused OIT, or even as a first-line treatment to rescue a primary prevention failure in early childhood. (c) 2023 Societe franc, aise d'allergologie. Published by Elsevier Masson SAS. All rights reserved.

Automated summary

Oral immunotherapy (OIT) is the only practical treatment for inducing tolerance in food-allergic patients, but adverse events often lead to treatment refusal or discontinuation. Epicutaneous (EPIT) and sublingual (SLIT) immunotherapies, developed concurrently with OIT, share immunological principles and expose patients to lower allergen doses. EPIT and SLIT are well tolerated and have a lower risk of severe allergic reactions compared to OIT.