Mechanisms of IgE-mediated food allergy and the role of allergen-specific B cells.

The substantial increase in food allergy prevalence during the last decades has made it a significant public health concern, affecting around 10% of the global population, especially children. Despite significant progress in understanding the general mechanisms of allergic sensitization, the development of oral tolerance remains a major challenge in advancing food allergy research and treatment. Additionally, each allergenic food source has a distinct immunological profile and tolerance trajectory, further complicating research efforts. Currently, oral allergen-specific immunotherapy is the only treatment that can help build tolerance to certain food allergens over time-although treatment outcomes vary. While B cells have been described and studied for their pathogenic role in food allergy, recent evidence suggests that they also modulate allergic responses through various effector and humoral functions. Notably, despite their low frequency, recent knowledge on the molecular and functional characteristics of food allergen-specific memory B cells has revealed important functions during both disease progression and therapeutic intervention. This review summarizes the current knowledge of IgE-mediated food allergy, highlighting the role of B cells, especially allergen-specific ones, in both disease and immune tolerance.