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MINI REVIEW article

Front. Allergy
Sec. Food Allergy
Volume 5 - 2024 | doi: 10.3389/falgy.2024.1473352
This article is part of the Research Topic Gut Microbiota Changes: A Key Driver of Increased Food Allergy Prevalence View all articles

Probiotics and other adjuvants in Allergen-Specific Immunotherapy for Food Allergy: A Comprehensive Review

Provisionally accepted
Maurizio Mennini Maurizio Mennini 1*Marisa Piccirillo Marisa Piccirillo 1Silvia Furio Silvia Furio 1Francesco Valitutti Francesco Valitutti 2Alessandro Ferretti Alessandro Ferretti 1Caterina Strisciuglio Caterina Strisciuglio 3MARIA DE FILIPPO MARIA DE FILIPPO 4,5Pasquale Parisi Pasquale Parisi 1Diego G. Peroni Diego G. Peroni 6Giovanni Di Nardo Giovanni Di Nardo 1Federica Ferrari Federica Ferrari 7
  • 1 Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
  • 2 Clinica Pediatrica, Dipartimento di Scienze Chirurgiche e Biomediche, Università degli Studi di Perugia, Perugia, Umbria, Italy
  • 3 Department of Women, Children And General and Specialist Surgery, University of Campania Luigi Vanvitelli, Naples, Campania, Italy
  • 4 Department of Maternal, Child and Urological Sciences, Umberto 1 Hospital, Rome, Lazio, Italy
  • 5 Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Lombardy, Italy
  • 6 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Tuscany, Italy
  • 7 Pediatric Unit, Sant'Eugenio Hospital, Rome, Italy., Rome, Italy

The final, formatted version of the article will be published soon.

    This review delves into the potential of manipulating the microbiome to enhance oral tolerance in food allergy, focusing on food allergen-specific immunotherapy (FA-AIT) and the use of adjuvants, with a significant emphasis on probiotics. FA-AIT, including oral (OIT), sublingual (SLIT), and epicutaneous (EPIT) immunotherapy, has shown efficacy in desensitizing patients and achieving sustained unresponsiveness (SU). However, the long-term effectiveness and safety of FA-AIT are still under investigation. Probiotics, particularly strains of Lactobacillus, play a crucial role in enhancing immune tolerance by promoting regulatory T cells (Tregs) and modulating cytokine profiles. These probiotics can induce semi-mature dendritic cells, enhance CD40 expression, inhibit IL-4 and IL-5, and promote IL-10 and TGF-β, thus contributing to mucosal defense and immunological tolerance. Clinical trials combining probiotics with FA-AIT have demonstrated improved desensitization rates and immune tolerance in food-allergic patients. For example, the combination of Lactobacillus rhamnosus with peanut OIT resulted in a significantly higher rate of SU compared to the placebo group, along with notable immune changes such as reduced peanut-specific IgE and increased IgG4 levels. The review also explores other adjuvants in FA-AIT, such as biologic drugs, which target specific immune pathways to improve treatment outcomes. Additionally, nanoparticles and herbal therapies like food allergy herbal formula 2 (FAHF-2) are discussed for their potential to enhance allergen delivery and immunogenicity, reduce adverse events, and improve desensitization. In conclusion, integrating probiotics and other adjuvants into FA-AIT protocols could significantly enhance the safety and efficacy of FA-AIT, leading to better patient outcomes and quality of life.

    Keywords: microbiome, oral tolerance, food allergy, Probiotics, Immunotherapy

    Received: 30 Jul 2024; Accepted: 23 Sep 2024.

    Copyright: © 2024 Mennini, Piccirillo, Furio, Valitutti, Ferretti, Strisciuglio, DE FILIPPO, Parisi, Peroni, Di Nardo and Ferrari. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Maurizio Mennini, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.