Trialling immunotherapy treatments for children with food allergy

Allergy to cow’s milk (CMA) is the most frequent food allergy in infancy. Although CMA is rarely fatal and most often resolves before adolescence, it has significant morbidity and may affect the quality of life and wellbeing of the family and the development of the child.

Currently, the formal management of the disease includes strict avoidance measures to prevent, and education to treat, potential reactions. Nevertheless, CMA is a condition amenable to treatment: a series of recent studies has shown that a procedure which gradually reintroduces milk into the diet is successful in desensitizing most patients. There are two major bottlenecks preventing the development of this CMA immunotherapy as a clinical tool: one is the diversity and lack of standardisation of the procedure to be used, and the second, most important, is the number of allergic reactions taking place during the process. A possible solution to address the latter is use of hypoallergenic allergen derivatives: molecules processed so that they lose much of their capacity to cause allergic reactions, while retaining their capacity to be recognised by the immune system.

Professor Nikos Papadopoulos has recently joined The University of Manchester and has a long-standing programme of research on food allergy. He is currently running two clinical trials: one for egg allergy and the other for fish allergy. The egg allergy trial is funded by Nestle and is testing a hypoallergenic preparation produced by Nestle. The fish allergy trial is using a genetically modified fish allergen and forms part of a wider programme of research, the Food Allergy Specific ImmunoTherapy (FAST) project,which is funded by EU FP7.

A further trial, of milk immunotherapy in young children with CMA, called the Standardization of milk-allergy Oral Immunotherapy for Use in Clinical Practice (SMILE) trial is currently being designed. The hypothesis is that early intervention with an appropriate antigen source will be able to accelerate resolution of milk allergy, while minimising adverse reactions. The trial will include detailed characterisation of the patients, trying to understand whether there are genetic or other factors, which relate to whether the treatment is successful or unsuccessful. The study has an ideal translational capacity, leading to a protocol applicable for clinical use upon completion of the trial.


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