A REVIEW OF THE INDUCTION OF TOLERANCE OF IgE-MEDIATED FOOD ALLERGY – PAST, PRESENT AND FUTURE THE PAST-FOOD ALLERGY A RARE MEDICAL ODDITY

This article reviews the recent advances and current state of equipoise in the use of immunotherapy for IgE-mediated food allergy. It examines the various methods currently under evaluation for induction of desensitisation and tolerance in food allergy and encompasses permissive diets which allow for inclusion of extensively heated food allergens, specific oral tolerance induction (SOTI), the use of adjuvants for specific tolerance induction and novel pharmacotherapies. a demand for services which are currently unmet. This has fostered desire to rethink late 20th century food allergy management of strict avoidance and monitoring for natural tolerance, to interventions which offer the hope of changing natural history and of inducing lifelong tolerance to food allergens in food allergic individuals. EXTENSIVELY HEAT-TREATED ALLERGENS AND PERMISSIVE ALLERGEN EXPOSURE In concert with the re-imagining of immunotherapy for food allergy, there has been a paradigm shift in management of food allergy over the last two decades. The previous mantra of strict avoidance of the food allergen has been increasingly challenged. Until recently, most allergy guidelines recommended strict avoidance of all forms and amounts of allergen for the diet of allergic children. This was partly on the basis of safety and also on the belief that accidental allergen exposure may delay the onset of tolerance. It is now widely held that this is unlikely to be the case, with a series of publications demonstrating that the majority of children allergic to hen’s egg and CM can tolerate extensively heated egg and CM in serving size quantities. WHAT ARE THE POTENTIAL BENEFITS OF PERMISSIVE ALLERGEN EXPOSURE IN CHILDREN WITH IgEMEDIATED ALLERGY TO EGG AND CM? There are potential positive effects which arise from the incorporation of extensively heat treated egg and milk in diets of egg and milk allergic children. The first is the lessening of dietary restrictions, potentially resulting in improved quality of life for both the allergic child and the family. The ability to incorporate extensively-heated CM