FAST: towards safe and effective subcutaneous immunotherapy of persistent life-threatening food allergies

Although reliable figures are still largely unavailable, IgE-mediated food hypersensitivity (hereafter referred to as food allergy) is thought to affect around 1-2% of adults and 4-8% of children, i.e. roughly around 10 million EU inhabitants (reviewed in [1,2]). Recent studies within the FP6-funded project EuroPrevall [3] showed tree nuts (hazelnut and walnut), fruits (apple, peach and kiwi) and peanut are the most common plant foods causing food allergy, followed by vegetables like carrot, tomato and celery. After milk and egg, fish and shrimp are most frequently causing food allergy to animal-derived foods (pers. comm. M. Fernandez-Rivas).The clinical presentation of food allergy varies from mild local symptoms of the oral cavity, usually referred to as the oral allergy syndrome (OAS), to severe systemic reactions which can include life-threatening anaphylaxis. In the U.S., food-induced anaphylaxis is estimated to cause about 120,000 emergency room visits and 3000 hospitalizations each year [4].The only available treatment for food allergy is avoidance, in conjunction with rescue medication in case of accidental exposure. However, hidden allergens in composite foods, unwanted contaminations and occasional poor adherence to dietary restrictions make avoidance difficult and ineffective. Therefore there is an urgent need to develop a treatment for food allergy that lowers the threshold significantly and makes avoidance less stringent. Allergen-specific immunotherapy (SIT) is the only treatment available that targets the immunological cause of the disease. It has proven successful in treatment of insect venom allergies and for respiratory allergies such as rhino-conjunctivitis and asthma to pollen and house dust mite [5-7], but due to the duration and invasiveness (i.e. 3-5 years of monthly subcutaneous injections) and the risk of anaphylactic side-effects, SIT is a niche treatment compared to symptomatic drugs, though new alternative routes have been recently succes