International perspective on obtaining disease modification with food allergy therapies.

BACKGROUND

A disease-modifying therapy aims to alter natural history by delaying or reversing disease progression.

OBJECTIVE

We examined expert opinion regarding the concept of disease modification in food allergy to assess consensus, definitions, and identification of relevant biomarkers.

METHODS

We contextualized relevant definitions to terms such as desensitization, sustained unresponsiveness, tolerance, and remission; and evaluated evidence-based disease-modifying effects of therapeutic strategies.

RESULTS

Evidence from oral, epicutaneous and sublingual immunotherapy demonstrates that desensitization is common and that a subset of patients has disease with sustained unresponsiveness or remission after treatment discontinuation. Younger age and lower baseline allergen-specific IgE may predict more durable responses. Immunologic changes associated with these outcomes include suppression of type 2 cellular responses, modulation of B-cell compartments, and induction of blocking antibodies. Currently approved biologics enhance protection during active treatment but have limited evidence for direct disease modification, although they may facilitate tolerance when combined with allergen exposure.

CONCLUSIONS

While the clinical states of desensitization, sustained unresponsiveness, tolerance, and remission may involve partial or complete disease modification in food allergy, no consensus definition exists, and no relevant biomarkers have been identified to date.