Randomized controlled trials investigating the role of allergen exposure in food allergy: where are we now?

Purpose of review The dramatic increase in food allergy stresses the need for more definitive treatment strategies that induce lasting oral tolerance in tandem with more effective approaches to primary prevention. Allergen-induced oral tolerance is now of prime interest in both of these settings as a potentially more effective approach to traditional avoidance strategies. Here, we review the recent randomized controlled trials (RCTs) examining the controlled allergen exposure in both treatment and prevention of food allergy. Recent findings Collectively, RCTs of oral immunotherapy (OIT) for the treatment of food allergy increase the amount of food allergen that can be tolerated. Allergic side-effects are common and this remains a major obstacle to general use in clinical practice. There are also at least eight RCTs currently in progress investigating early allergen exposure for the primary prevention of food allergy. Summary OIT is showing promise as a possible treatment for food allergy; however, more large, longitudinal studies are needed to optimize both safety and efficacy and to assess the long-term effects, before this can be considered in clinical practice. The results of the primary prevention studies will be of great importance in determining the role of earlier introduction of allergenic foods in reducing the burden of food allergy.